Laparoscopic Pyeloplasty provides patients with a safe and
effective way to perform reconstructive surgery of a narrowing or
scarring where the ureter (the tube that drains urine from the kidney
to the bladder) attaches to the kidney through a minimally invasive
This operation is used to correct a blockage or narrowing of the
ureter where it leaves the kidney. This abnormality is called a
ureteropelvic junction (UPJ) obstruction which results in poor and
sluggish drainage of urine from the kidney. UPJ obstruction can
potentially cause abdominal and flank pain, stones, infection, high
blood pressure and deterioration of kidney function.
When compared to the conventional open surgical technique, laparoscopic
pyeloplasty has resulted in significantly less post-operative pain,
a shorter hospital stay, earlier return to work and daily activities,
a more favorable cosmetic result and outcomes identical to that
of the open procedure.
Johns Hopkins Hospital Patients and Johns
Hopkins Bayview Medical Center Patients please
use the phone numbers listed above.
In the event of an emergency and you need to contact someone in the evening hours
or on the week end, please call the paging operator at 410-955-6070 (for
Johns Hopkins Hospital Patients) or 410-550-0100 (for
Johns Hopkins Bayview Medical Center Patients) and ask to speak to the urologist
For directions to Johns Hopkins
Hospital please click
PRIOR TO THE SURGERY
During your initial consultation with your
surgeon, he will review your medical history as well as any
outside reports, records, and outside X-ray films (e.g. CT
scan, MRI, sonogram, renal scans, etc.).
A brief physical examination will also be
performed at the time of your visit. If your surgeon determines
that you are a candidate for surgery, you will then meet with
a Patient Service Surgery Coordinator to arrange for the date
of your operation.
NOTE: It is very important that
you gather and bring all of your X-ray films and reports to
your initial consultation with your surgeon.
What to expect prior to the surgery
Since insurance companies will not permit patients to be admitted
to the hospital the day before surgery to have tests completed,
you must make an appointment to have pre-operative testing
done at your family doctor or primary care physician's office
within 1 month prior to the date of surgery.
These results need to be faxed by your doctor's
office to the Pre-operative Evaluation Center
two weeks prior to your surgery. Please call The Documentation
Center at 410-955-9453
two weeks before your surgery date to confirm that this information
Once your surgical date is secured, you will receive a form
along with a letter of explanation to take to your primary
care physician or family doctor in order to have the following
preoperative testing done prior to your surgery.
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood
Medications to Avoid Prior to Surgery
Aspirin, Motrin, Ibuprofen, Advil, Alka
Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex,
Voltaren, Vioxx, Plavix and some other arthritis medications
can cause bleeding and should be avoided 1 week
prior to the date of surgery (Please contact your
surgeon’s office if you are unsure about which medications
to stop prior to surgery. Do not stop any medication without
contacting the prescribing doctor to get their approval).
Bowel Preparation and Clear Liquid
Do not eat or drink anything after midnight the night before
the surgery and drink one bottle of Magnesium Citrate (can
be purchased at your local pharmacy) the evening before
Drink only clear fluids for a 24-hour
period prior to the date of your surgery. Clear liquids
are liquids that you are able to see through. Please follow
the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after
midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
- Clear Broths (no cream soups, meat,
- Juices (no orange juice or tomato
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Kool Aid
- Gator Aid
- Tea (you may add sweetener, but no cream
- Coffee (you may add sweetener, but no
cream or milk)
- Clear Jello (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (no marshmallow)
Laparoscopic pyeloplasty is performed under
a general anesthetic. The typical length of the operation
is 3-4 hours. The surgery is performed through 3 small (1cm)
incisions made in the abdomen. A telescope and small instruments
are inserted into the abdomen through these keyhole incisions,
which allow the surgeon to repair the blockage/narrowing without
having to place his hands into the abdomen.
A small plastic tube (called a ureteral
stent) is left inside the ureter at the end of the procedure
to bridge the pyeloplasty repair and help drain the kidney.
This stent will remain in place for 4 weeks and is usually
removed in the doctor's office. A small drain will also be
left exiting your flank to drain away any fluid around the
kidney and pyeloplasty repair.
Junction (UPJ) Obstruction
Laparoscopic dismembered pyeloplasty
Potential Risks and Complications
Although this procedure has proven to be
very safe, as in any surgical procedure there are risks and
potential complications. The safety and complication rates
are similar when compared to the open surgery. Potential risks
- Bleeding: Blood loss during this procedure
is typically minor (less than 100 cc) and a blood transfusion
is rarely required. If you are still interested in autologous
blood transfusion (donating your own blood) prior to your
surgery, you must make your surgeon aware. When the packet
of information is mailed or given to you regarding your
surgery, you will receive an authorization form for you
to take to the Red Cross in your area.
- Infection: All patients are treated
with broad-spectrum intravenous antibiotics prior to starting
the surgery to decrease the chance of infection from occurring
after surgery. If you develop any signs or symptoms of infection
after the surgery (fever, drainage from your incision, urinary
frequency, discomfort, pain or anything that you may be
concerned about) please contact us at once.
- Hernia: Hernias at incision sites rarely
occur since all keyhole incisions are closed carefully at
the completion of your surgery.
- Tissue / organ injury: Although uncommon,
possible injury to surrounding tissue and organs including
bowel, vascular structures, spleen, liver, pancreas and
gallbladder could require further surgery. Injury could
occur to nerves or muscles related to positioning.
- Conversion to open surgery: this surgical
procedure may require conversion to the standard open operation
if extreme difficulty is encountered during the laparoscopic
procedure. This could result in a larger standard open incision
and possibly a longer recuperation period.
- Failure to correct UPJ obstruction: Roughly
3 % of patients undergoing this operation will have persistent
blockage due to recurrent scarring. If this occurs additional
surgery may be necessary.
WHAT TO EXPECT AFTER
During your hospitalization
Immediately after the surgery you will be
taken to the recovery room and transferred to your hospital
room once you are fully awake and your vital signs are stable.
- Hospital Stay: The length of hospital
stay for most patients is approximately 1-2 days.
- Diet: You can expect to have an intravenous
catheter (IV) in for 1-2 days. (An IV is a small tube placed
into your vein so that you can receive necessary fluids
and stay well hydrated until you are able to tolerate a
diet; in addition it
provides a way to receive medication). Most patients are
able to tolerate ice chips and small sips of liquids the
day after surgery and regular food the next day. Once on
a regular diet, pain medication can be given by mouth instead
of by IV or shot.
- Postoperative Pain: Pain medication
can be controlled and delivered by the patient via an intravenous
patient-controlled analgesia (PCA) pump or by injection
(pain shot) administered by the nursing staff. You may experience
some minor transient shoulder pain (1-2 days) related to
the carbon dioxide gas used to inflate your abdomen during
the laparoscopic surgery.
- Nausea: You may experience some nausea
related to the anesthesia or pain medication. Medication
is available to treat persistent nausea.
- Urinary Catheter: You can expect to
have a urinary catheter draining your bladder (which is
placed in the operating room while the patient is asleep)
for approximately 2 days after the surgery. It is not uncommon
to have blood tinged urine for a few days after surgery.
- Drain: You will have a drain coming
out of a small incision in your side. This drain is placed
in the operating room around the operative site to prevent
blood and fluid from building up around the kidney and pyeloplasty
repair. The drainage typically appears blood-tinged. It
is usually removed the day the urinary catheter is removed.
If persistent high volume drainage occurs, you may have
to go home with the drain and have it removed in your doctor's
- Fatigue is common and should subside
within a few weeks following surgery.
- Incentive Spirometry: You will be expected
to do some very simple breathing exercises to help prevent
respiratory infections by using an incentive spirometry
device (these exercises will be explained to you during
your hospital stay). Coughing and deep breathing is an important
part of your recuperation and helps prevent pneumonia and
other pulmonary complications.
- Ambulation: On the day after your surgery
it is very important to get out of bed and begin walking
under the supervision of your nurse or family member to
help prevent blood clots from forming in your legs. You
can expect to have SCD's (sequential compression devices)
along with tight white stockings to prevent blood clots
from forming in your legs.
- Constipation/Gas Cramps: You may experience
sluggish bowels for several days following surgery as a
result of the anesthesia. Suppositories and stool softeners
are usually given to help with this problem. Taking a teaspoon
of mineral oil daily at home will also help to prevent constipation.
Narcotic pain medication can also cause constipation and
therefore patients are encouraged to discontinue any narcotic
pain medication as soon after surgery as tolerated.
What to expect after discharge
from the hospital
- Pain control: You can expect to have
some pain that may require pain medication for up to a week
after discharge, and then Tylenol should be sufficient to
control your pain.
- Showering: You may shower after returning
home from the hospital. Your wound sites can get wet, but
must be padded dry immediately after showering. Tub baths
are not recommended in the first 2 weeks after surgery as
this will soak your incisions and increase the risk of infection.
You will have adhesive strips across your incisions. They
will fall off in approximately 5-7 days on their own. Sutures
underneath the skin will dissolve in 4-6 weeks.
- Activity: Taking walks are advised.
Prolonged sitting or lying in bed should be avoided. Climbing
stairs is possible, but should be taken slowly. Driving
should be avoided for at least 1-2 weeks after surgery.
Absolutely no heavy lifting (greater than 20 pounds) or
exercising (jogging, swimming, treadmill, biking) until
instructed by your doctor. Most patients return to full
activity on an average of 3 weeks after surgery. You can
expect to return to work in approximately 2-4 weeks.
- Follow up appointment: You will need
to call the Johns Hopkins Out Patient Urology Clinic at
410-955-6707 after your surgery date to schedule a follow
up appointment as instructed by your surgeon...
- Stent follow up: The stent will remain
in place for approximately one month and will then be removed
in the doctor's office through a cystoscope (a small telescoped
passed down the urethra to retrieve the stent). It is not
uncommon to feel a slight amount of flank fullness and urgency
to void, which is caused by the stent. These symptoms often
improve over time.