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Q: Two Questions About Hydronephrosis Surgery ( Answered 5 out of 5 stars,   0 Comments )
Subject: Two Questions About Hydronephrosis Surgery
Category: Health > Men's Health
Asked by: trai-ga
List Price: $50.00
Posted: 26 Jul 2006 08:08 PDT
Expires: 25 Aug 2006 08:08 PDT
Question ID: 749727
I'm a thirty-year-old male and it looks like I will have to have
surgery to deal with Hydronephrosis.  The urologist has explained that
a ureter will need to be detached from the right kidney, shortened (to
remove the blockage causing the Hydronephrosis,) and then reattached.

Two Questions
What is the average time spent in a US hosptial from admittance to
discharge for such a surgery?

What is the recommended recovery time in the US after such a surgery
until the patient can particpate in physical fitness activities and/or
lift objects heavier than 15 lbs?

Request for Question Clarification by keystroke-ga on 26 Jul 2006 08:42 PDT
Hi trai,

I'd be happy to help you with your question. But in order to do so,
I'll need to know whether the surgery will be "open" or
"laparoscopic."  These two different types of the same surgery have
different recovery times and hospital stays.

Request for Question Clarification by welte-ga on 26 Jul 2006 13:41 PDT
It would also be helpful to know why you have hydronephrosis, e.g., a
stone blocking the ureter, reflux, etc.


Clarification of Question by trai-ga on 27 Jul 2006 00:41 PDT
For keystroke-ga:

I do not know which method will be used but thank you for drawing my
attention to the different possibilities.  Let's take the best case
which I'm assuming would be for laparoscopic surgery.

For welte-ga:

I have a congenital defect in the right ureter: a stenosis which
constricts the flow of urine and causes the Hydronephrosis.
Subject: Re: Two Questions About Hydronephrosis Surgery
Answered By: crabcakes-ga on 27 Jul 2006 22:23 PDT
Rated:5 out of 5 stars
Hello Trai,

   Surgery to correct hydronephrosis is called pyeloplasty.

   Post-surgical activities can be resumed fairly quickly, but it will
depend on your own circumstances - type of surgery, your medical
condition, and your doctor?s recommendations. You will see that each
site recommend a different time table as well. Most information I
found regarding activities pertained to children, as is the following:

?Encourage quiet activities. No physical activity for 2 weeks or until
the stent is removed (whichever is longer).?

Avoid activities such as:
? gym
? swimming
? running
? climbing toys
? bike-riding
? skating

What else do I need to know?
A kidney ultrasound will be done 4 to 6 weeks after surgery. A renogram will also
be done if needed.

When should I call the surgeon?
? urinating less often than usual
? urine smells bad
? change in urine color
? increase in pain
? fever higher than 101.5F (by mouth)
? incision looks red or swollen
? drainage from the incision
Most information was geared towards children.

   This University of Maryland site recommends 4 days to a week off from work:
?Time Off Work - Plan on a total of 4-7 days off work including the
surgical day. This will allow for quiet days at home to recover from
the surgery.?

   ?The total hospital stay will be on average 5 days.? ?The wound
sites will be covered with a light dressing and any stitches to these
sites will dissolve in 2-3 weeks, alternatively you may have steri
strips over these sites and these can be removed after 5-7 days.?

?It may take 6 weeks for you to fully recover from this surgery.
It is important to avoid heavy lifting and strenuous exercise during this period.
We recommend that you should avoid driving for 2 weeks.
You will be given an appointment to have your stent removed in 6 weeks time.
You will be seen in out patients approximately 3 months after surgery.?

   ?You should expect some discomfort after the operation, which
should be easily controlled by the pain-killers prescribed. Most
patients leave hospital 2-4 days after the surgery. The success rate
to date for patients not previously operated on for this condition is
100% in our series. Be sensible when you are at home - you will have
had a major operation so you should not undertake strenuous physical
exercise, even if you feel like it, until the stent has been removed.
You may drive as soon as you think you could brake hard and swerve
quickly to avoid an accident (typically 2 weeks).?

   ?The classic treatment of UPJ obstruction is an open operation to
remove the UPJ and to reattach the ureter to the pelvis of the kidney
creating a wide junction between the two. This operation, called a
pyeloplasty, allows rapid and easy drainage of urine produced by the
kidney and relieves symptoms and the risk of infection. The procedure
usually takes a few hours and has a success rate in excess of 95
percent with one operation. Hospitalization after surgery depends on
age of the patient. There are a variety of drainage tubes utilized to
promote healing and their use is dependent on the surgeon's
preference. The incision is usually just below the ribs and just
behind a line that would pass from the patient's arm to their leg on
the affected side. The incision is usually two to three inches long.

Newer treatment of UPJ obstruction involves minimally invasive
surgery. There are two options, a laparoscopic pyeloplasty and an
internal incision of the UPJ. Laparoscopic surgery is done by placing
several instruments through the abdominal wall and performing the
surgical procedure. This procedure is most often done through the
abdominal cavity and has the disadvantage of potentially causing
scarring or adhesions within the abdomen. Surgeons also cannot utilize
techniques that are as delicate in a laparoscopic as in an open

 The clear advantages of laparoscopic surgery are less pain and nausea
especially in older children and adults. Success rates of laparoscopic
pyeloplasty are just being determined but we would expect that they
would approach the effectiveness of open surgery with time. The second
option is to insert a wire through the ureter and use it to cut the
tight and narrow UPJ from the inside. A special ureteral drain is then
left in place for several weeks and then removed. The UPJ heals in a
more open manner in most patients but the treatment may need to be
repeated and success rates are clearly less than those of open
surgery. The advantages of this procedure are less pain and nausea.?

?After repair of UPJ obstruction, there is usually swelling of the
ureter and continued poor drainage of the kidney for a period of time.
This usually changes as the area heals. The surgeon usually obtains a
functional test, a few weeks after the procedure, to evaluate how well
the kidney is working. Patients usually recover quickly from any of
the procedures but some have pain for a few days following surgery and
occasionally a drainage tube must be left in place to help drain the
kidney while it heals. The appearance of the kidney can continue to
improve for years but usually it never looks normal on ultrasound or
other studies. Once repaired, a UPJ obstruction almost never recurs.
There is nothing that the family can do to prevent further problems
with the kidney. Patients may have a slightly increased risk of
developing stones and infection throughout their lives because many of
the kidneys still contain some pooled urine even though their overall
drainage is improved after surgery.?

   ?Are any artificial parts used in the pyeloplasty surgery?
No. The original ureter is surgically approached below the level of
the obstruction and the abnormal section is removed. Then the ureter
is repositioned and reattached to the healthy renal pelvic tissue
Where is the incision?

The surgery can be done from a few different angles. In general, the
incision will be on your child's side. Your surgeon will discuss the
location of the incision that is the most appropriate for your child.
All of the surgical stitches called sutures will dissolve.
Occasionally, one skin suture is removed 10 days or so after the
operation if a tube is inserted.?
Please check this site for further information.

Open pyeloplasty 

?Results: Mean operation time was 1 h and mean hospital stay was 3 days.?

   "Open pyeloplasty remains the criterion standard for the treatment
of UPJ obstruction. Although many variations exist in the methodology,
this procedure typically involves the surgical excision of the
narrowed segment of the UPJ and performance of a spatulated
reanastomosis of the renal pelvis to the ureter. If significant
dilation of the renal pelvis occurs, it is often reduced in size by
trimming off redundant tissue, and then it is tailored in such a
fashion that it funnels down towards the anastomosis. If an accessory
or aberrant vessel exists near the UPJ, the anastomosis is positioned
anterior to the vessel.

An open pyeloplasty can be performed through a variety of incisions
but is most likely performed through an extraperitoneal flank
incision. Depending on the surgeon's preference and the function of
the kidney postoperatively, a nephrostomy tube is occasionally left in
place, or, more often, a ureteral stent that passes from the renal
pelvis to the bladder is placed. A drain is usually placed near the
anastomosis and removed postoperatively when the output becomes
minimal. Generally, the external drain is removed after the patient's
bladder Foley catheter is removed and after a trial of having the
nephrostomy tube (if present) clamped to ascertain that neither
maneuver will increase drainage from the anastomosis.

The advantages of this operation include excellent exposure of the
UPJ, familiar anatomy for essentially all urologists, the ability to
tailor the renal pelvis as needed, and the performance of a watertight
anastomosis. The disadvantages include the large surgical incisions
and the associated postoperative pain and convalescence.?

   Following recovery from anesthesia, the patient is generally given
ice chips and, perhaps, clear liquids at the end of surgery if they
have no clinical evidence of an ileus. If not, liquids are deferred
until the following morning. Prompt mobilization of the patient and a
pulmonary toilet is maintained postoperatively. Pain is controlled
with either a morphine patient-controlled analgesia device or, in some
cases, an epidural catheter. Once patients are tolerating a general
diet, they are switched to oral pain medication. Antibiotics are
continued until the drain is removed. The drain is removed once the
output is deemed minimal. The Foley catheter is generally removed on
the second or third postoperative day, and the patient is discharged.?

?OPEN PYELOPLASTY - Open pyeloplasty has been the "gold standard" for
surgical treatment of UPJO with a success rate of 90%.

Advantages: Neither the antegrade nor retrograde endourological
approach achieves results to open pyeloplasty.

Disadvantages: Several draw backs, which include significant
postoperative pain, prolonged convalescence and a prominent skin

   "Postoperative phase: After the procedure is completed, you will be
placed back on the OR stretcher with total help from the surgical team
and wheeled into the recovery room where you will be monitored by the
recovery room nurses. They will check your blood pressure, pulse,
respirations, temperature and drainage from your tubes. When you are
awake you will go to your hospital room and the floor nurses will then
take over. You may still be drowsy from the anesthesia, but as this
begins to wear off, you might experience some discomfort where the
manipulation took place. You will be given an injection of pain
medication upon request and the effectiveness of the medication will
be monitored. If it is not strong enough for the pain you are
experiencing, it may be increased according to your doctor's orders.
The pain should begin decreasing each day in which case the dosage
will be adjusted. The medication will eventually be changed to pills
when you are tolerating fluids and food, usually within 4-48 hours.

Getting ready for discharge: A clear liquid diet will be started on
the first postoperative day. The drainage tube will be removed
according to the amount of drainage. This will be usually the 2nd to
3th post-operative day. The double-J stent will be left inside your
ureter for 4-6 weeks depending on the blockage, and whether there had
been previous surgery. Total hospital days usually are 2-3 days. Upon
discharge, you will be given printed discharge instructions. Please
ask for these before you leave the hospital.

Policy of follow up: You should make an appointment to see your
urologist within 10-14 days following your discharge. With the
double-J stent inside your ureter, you might experience some related
symptoms like mild flank or groin pain, hematuria, urgency and
frequency. If urinary tract infection with fever and chills develops,
a possible subsequence of the stent, you should immediately contact
your urologist. This stent will be removed in the office under local
anesthesia 4-6 weeks after the procedure. Six months after the
procedure, a repeat renal scan will be performed to see how the ureter
has healed."

Laparoscopic Pyeloplasty

?LAPAROSCOPIC PYELOPLASTY - The average operating time is 5 hours. The
mean hospital stay is 3 days.?

   In children, the stay for laparoscopic averaged 1-5 days, compared
to 3-7 days for open surgery.

   ?The laparoscopically treated patients demonstrated significantly
lower analgesic requirements (27.2 v 124.2 mg of morphine sulfate
equivalent; P = 0.02) and shorter hospital stays (1.4 v 3.0 days; P =
0.03) than the open surgery patients. The Acucise patients
demonstrated shorter operative time (1.7 v 3.4 hours; P < 0.001),
shorter hospital stay (1.3 v 3.0 days; P = 0.02), and lower analgesic
requirement (22.4 v 124.2 mg of morphine sulfate equivalent; P = 0.02)
than the open surgery patients.

Conclusions: Laparoscopic pyeloplasty achieves a success rate equal to
that of open pyeloplasty while providing a recovery similar to that
obtained with Acucise endopyelotomy and is gaining popularity as the
treatment of choice for UPJ obstruction.?

?Hospital Stay: The length of hospital stay for most patients is
approximately 1-2 days.?

?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.?
Please check this site for additional information. You will also find
diagrams showing the site of incision for open and laparascopic

   ?Significant hydronephrosis is considered one of the indications
for laparoscopic pyeloplasty. The patient with extremely patulous
renal pelvis do not do as well with the endoscopic approach. The
significantly distended and patulous renal pelvis may be synonymous
with the "neurogenic bladder" and may not have the propulsive effect
of a normal renal pelvis. These patulous renal pelvises are considered
ideal for trimming of the excess renal pelvic tissue and thus are
ideal for laparoscopic pyeloplasty.?

   ?In the hands of experienced surgeons, laparoscopic pyeloplasty
offers a less invasive alternative to open surgery with decreased
morbidity, shorter hospital stay, and faster convalescence. During the
last decade, laparoscopic pyeloplasty for the treatment of congenital
or acquired UPJ obstruction has garnered much interest, but, as this
procedure is technically challenging, it is being performed only at
selected medical centers by surgeons with advanced laparoscopic
training. This review describes the early results, ongoing evaluation,
and future role for this novel surgical procedure.?

Laproscopic Recovery
?Postoperative recovery from laparoscopic procedures is generally
quicker than with its open counterpart. The patient is generally fed
the evening of the day of surgery or the following day. Because a
double-J stent is placed, output from the drain is usually minimal and
it can often be removed very quickly. Postoperative pain is usually
managed with oral pain medicine. Antibiotics are continued until the
drain is removed or at a minimum of 24 hours. The double-J stent is
generally removed 4-6 weeks postoperatively.?

   ?In adult patients, laparoscopic pyeloplasty for PUJ obstruction is
as successful as open pyeloplasty, but with less morbidity [6?8]. The
technical difficulty of intracorporeal suturing has prevented its
frequent use in children [9,10]. Recently, there have been some
improvements in laparoscopic suturing instruments, e.g. the automatic
laparoscopic suturing device, but these are not delicate enough for
intracorporeal suturing with fine sutures in children [7] and
intracorporeal suturing remains a major obstacle to laparoscopic
pyeloplasty in children. Tan and Roberts [10] used a ?hitch-stitch?,
which stabilized the pelvis and facilitated suturing during
dismembered pyeloplasty, reducing the operative duration. They
inserted a JJ catheter, which may be advisable in the presence of
active inflammation, after a difficult repair or with a solitary
kidney, but has the added morbidity of requiring general anaesthesia
to remove the stent in children. In a meticulously sutured watertight
pelvic-ureteric anastomosis with a ?no-touch? technique, as in open
surgery, stents or nephrostomy tubes are probably unnecessary.?

   ?After repair of UPJ obstruction, there usually is swelling of the
ureter and continued poor drainage of the kidney for a period of time.
This usually changes as the area heals. The surgeon normally obtains a
functional test a few weeks after the procedure to evaluate how well
the kidney is working. Patients typically recover quickly from any of
the procedures, but some have pain for a few days after surgery.
Occasionally, a drainage tube must be left in place to help drain the
kidney while it heals. The appearance of the kidney can continue to
improve for years, but usually it never looks normal on ultrasound or
other studies. Once repaired, a UPJ obstruction almost never recurs.
There is nothing that the family can do to prevent further problems
with the kidney. Patients may have a slightly increased risk of
developing stones and infection throughout their lives because many of
the kidneys still contain some pooled urine even though their overall
drainage is improved after surgery.?

DaVinci Robotic Surgery

?All procedures were completed without conversion or complications.
Robot docking time averaged 6 minutes. Anastomotic time was 57 minutes. Total
operative time was 200 minutes. Estimated blood loss averaged 10ml. Methylene
blue was used to test the anastomosis. Patients were mobile 5 hours
later, discharged home 18.5 hours post-extubation, and returned to
normal activity within 10 days.?

This article is great additional information on different surgeries:

I hope this has helped you understand more about your future surgery.
If anything is unclear, please request an Answer Clarification, and
allow me to respond, before you rate this answer.

I wish you well!

Sincerely, Crabcakes

Search Terms
laparoscopic pyeloplasty
open pyeloplasty
post-surgical activities + laparoscopic pyeloplasty
post-surgical activities + open pyeloplasty
hospital stay + laparoscopic pyeloplasty
hospital stay + open  pyeloplasty
trai-ga rated this answer:5 out of 5 stars
Very thorough.  You introduced me to some new terms and resources
which have siginificantly helped to find more information.

There are no comments at this time.

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