Robotic Ureterolysis and Pyeloplasty

Urine is made in the kidneys. From there, it travels through the ureters to the bladder. It is stored in the bladder until you are ready to urinate. However, sometimes urine cannot get from the kidneys to the bladder because there is a blockage. This can be a serious problem. Your caregiver may suggest robotic surgery to fix this. A computer is used to control tiny instruments attached to a robot. This type of surgery usually involves less pain, less blood loss, less scarring, and a faster recovery.

The type of blockage can vary. Different procedures can be used.

  • Ureterolysis. This may be done if a mass of tissue, such as a scar, is causing the blockage. A scar may exist on the outside of the ureter and squeeze (constrict) the ureter closed. The urine cannot get through and backs up into the kidneys. Ureterolysis releases the ureter from the scar, but it does not remove the scar. Because the scar remains, it often grows around the ureter and blocks it again. In an attempt to prevent this, the surgeon may try other techniques to prevent the scar from constricting the ureter tube again.

  • Pyeloplasty. This may be done if a mass is blocking the inside of the ureteropelvic junction (UPJ). The UPJ is the connecting point between the ureter and the kidney. The mass might be scar tissue, a fluid-filled sac (cyst), or a growth. The blockage can also be caused by a blood vessel crossing in front of the ureter where it connects into the kidney. This blockage makes the junction too tight and urine cannot get through. Pyeloplasty removes the mass or repositions the constricted area in front of the blood vessel.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to food or medicine.

  • Medicines taken, including vitamins, herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicines.

  • History of bleeding problems or blood clots.

  • Previous surgery.

  • Other health problems, including diabetes and kidney problems.

  • Possibility of pregnancy, if this applies.

RISKS AND COMPLICATIONS

Short-term possibilities include:

  • Urine leaking in the area where you had surgery.

  • A return of urine blockage.

  • Damage to the ureter.

  • Damage to surrounding organs.

  • Fatigue for several weeks.

  • Bleeding.

  • Pain.

  • Infection.

  • Slow healing.

  • Pooling of blood under the surgical cut (hematoma).

  • Swelling around the surgical cut.

  • Bruising or swelling in the abdomen.

  • Bruising or swelling where the intravenous (IV) access was put in your hand or arm.

  • An allergic reaction.

  • Blood clots.

Long-term possibilities include:

  • Scarring.

  • Skin damage.

  • Damage to blood vessels or organs in the area.

  • Need for additional surgery.

BEFORE THE PROCEDURE

  • Understand the type of procedure you are going to have. The surgeon may need to make a change during the surgery. The robotic procedure may be stopped and an open surgery may be started. This ability to perform open surgery is a backup benefit to assure that your problem can be corrected. If you have any questions, talk to your caregiver before surgery.

  • Arrive at least 1 hour before the surgery, or whenever your caregiver recommends. This will give you time to check in and fill out any needed paperwork.

  • You may be asked to stop taking certain medicines for several days or weeks prior to your procedure, such as blood thinners (including aspirin). Ask your caregiver when you should stop taking blood thinners (anticoagulants).

  • Do not eat or drink for at least 6 hours before surgery.

  • You may be asked to shower with a soap that kills skin bacteria (antibacterial shower).

  • Arrange for someone to drive you home.

PROCEDURE

  • Small monitors will be placed on your body. They check your heart, blood pressure, and oxygen level.

  • You will be given an IV. Medicine will flow directly into your body through the IV.

  • You may be given a medicine to help you relax (sedative).

  • You will be given a drug that makes you sleep during the surgery (general anesthetic).

  • The surgeon will make several small cuts (incisions) in your abdomen once you are asleep.

  • Small tubes carrying a tiny camera and tools will be put through the incision.

  • If a ureterolysis procedure is done, the ureter may not need to be opened (unless the scar outside the ureter has caused a scar inside the ureter). The ureter will simply be released from the tissue or scar blockage. You may not need stents that can be placed in the ureter to drain the kidney.

  • If a pyeloplasty procedure is done, the ureter must be opened (and sometimes a section of the ureter needs to be cut out). This is because the ureter is blocked from tissue inside the ureter. A stent is almost always placed. The stent keeps urine from draining out of the incision before the ureter is healed and helps the ureter to heal more quickly. This tube will be removed at a later date.

  • Sometimes, the blockage will cause kidney stones to form in the kidneys. These will be removed when the incision is made into the junction of the ureter and kidney.

  • A thin tube (catheter) may be put into the bladder. This is done to keep track of how much urine you are producing.

  • The incisions will be closed with staples or small stitches (sutures).

  • The procedure may take 1½ to 3 hours.

AFTER THE PROCEDURE

  • You will stay in a recovery area until the anesthesia has worn off. Your blood pressure and pulse will be checked. Then, you will be taken to a hospital room.

  • You may continue to get fluids through the IV.

  • Your urine output will be measured.

  • The catheter in your bladder might be uncomfortable, but this is usually minimal.

  • A flat, rubber drain may be placed in your side near the bottom of your ribs. It will be sewed in with a stitch. Drainage from it should be minimal and will be blood-tinged. The drain allows your caregiver to watch for any excessive bleeding or urine leakage from the incision if a pyeloplasty was done. It will be removed the day you are discharged from the hospital.

  • You will be able to walk the same day as surgery and should do so quickly to help prevent blood clots in the legs.

  • Anesthesia and pain medicine make your intestines slow down for a few days. You may have increased gas pains and have trouble having a bowel movement (constipation). Limit your diet to liquids until you begin to pass gas frequently. A regular diet can usually be started the following day. Your appetite may be poor for about 1 week.

  • Minimal blood loss is expected.

  • You will be given pain medicine. Some pain is normal, but tell your caregiver if the pain continues.

  • You may be required to stay in the hospital for 1 to 2 days after the procedure. Some people can go home the day of surgery or the next day. Ask your caregiver what to expect.

  • Follow-up care can differ depending on your caregiver and the type of surgery you had.

  • Go back to your normal routine slowly. Ask your caregiver if you have questions about a specific activity. Ask when it will be okay for you to drive.

  • Ask your caregiver when you can go back to work. This will depend on the type of work you do.

  • If you had a stent placed in your ureter, the surgeon will remove it in 4 to 6 weeks.