What is Robot Assisted Ureterolysis and Pyeloplasty

Robotic assisted ureterolysis and pyeloplasty are two procedures to remove a blockage in the ureter or the ureteropelvic junction (UPJ). Ureters are tubes that connect the organs that make urine (kidneys) to the organ that stores urine (bladder).

The UPJ is the connection between the ureter and part of the kidney (renal pelvis). During these procedures, a computer is used to control surgical instruments that are attached to robotic arms.

Ureterolysis may be done when a ureter is blocked by something outside of the ureter. Usually, the blockage is caused by scar tissue pushing against the ureter, which squeezes (constricts) the ureter closed. Scar tissue may be the result of previous surgery, infections, or inflammation. During ureterolysis, the ureter is moved away from the scar tissue to open the ureter, but the scar tissue is not removed.

Pyeloplasty may be done when the ureter is blocked or constricted by something inside of the UPJ. The blockage may be caused by scar tissue, a fluid-filled sac (cyst), a growth, or a kidney stone. The blockage may also be caused by a blood vessel crossing in front of the UPJ. During pyeloplasty, the blockage is removed, unless the blockage is caused by a blood vessel. If the blockage is caused by a blood vessel, the blood vessel is moved away from the UPJ.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs, such as the ureter or the intestines.
• A return of the urine blockage.
• Urine leakage.
• Blood clots.

What happens before the procedure?

• Make sure you understand the type of procedure that you are going to have. During the procedure, the robotic-assisted procedure may be stopped and an open surgery may be started. An open surgery means that the surgeon will make a larger incision and perform the procedure by hand. Your surgeon will decide if this is necessary during the procedure. If you have questions, talk with your health care provider.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• You may be asked to bathe or shower using a soap that kills skin bacteria.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may have an exam or testing.
• You may have a blood or urine sample taken.
• Plan to have someone take you home after the procedure.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from your surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic). You may also be given a medicine to help you relax (sedative).
• A thin, flexible tube (catheter) will be passed through your urethra and into your bladder. The catheter will drain urine from your bladder during the procedure.
• Several small incisions will be made in your abdomen.
• A thin tube with a light and a small camera on the end (laparoscope) and other surgical instruments will be passed through your incisions to perform the procedure.
• Carbon dioxide gas may be put into your abdomen. This stretches your abdomen so that your surgeon can see your organs.
• If a pyeloplasty is done, the blockage will be removed by making an incision in your ureter or your UPJ and removing the blockage, or by moving the blood vessel causing the blockage.
  • In some cases, part of your ureter may be removed, or you may need to have a soft plastic tube (stent) inserted into your ureter to prevent urine from draining out of the incision in your ureter while the incision heals.
  • If an incision is made in your ureter or your UPJ, your incision will be closed with stitches (sutures).
• If a ureterolysis is done, your ureter will be moved away from the source of the blockage. You may not need a stent.
• If necessary, kidney stones will be removed.
• A drainage tube may be placed in your abdomen.
• The incisions in your abdomen may be closed with sutures, skin glue, or adhesive tape.
• Incisions may be covered with bandages (dressings).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may continue to receive fluids and medicine through an IV tube.
• You will have some pain. Pain medicines will be available.
• You will be encouraged to walk around as soon as possible.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will have a catheter draining your urine.
• You may have a tube draining fluid from your surgical area.
• You may be kept on a liquid diet. You may not be able to eat solid food until you pass gas or have a bowel movement.
• Do not drive for 24 hours if you received a sedative.

Robot-Assisted Ureterolysis and Pyeloplasty, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Fewer bowel movements than usual (constipation) and moderate discomfort due to gas. This may last for several days.
• Decreased appetite for up to 1 week.
• Soreness and mild pain in your abdomen.
• Soreness or mild discomfort from your catheter. After your catheter is removed, you may have mild soreness, especially when urinating.
• Mild pain under your rib cage, in your back, or in your shoulder.
• Nausea for up to 2 days.
• A small amount of blood or clear fluid coming from your incisions.
• A small amount of blood in your urine. This may last for several days.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Do not drive for 24 hours if you received a sedative.
• Do not drive or operate heavy machinery while taking prescription pain medicines.

Incision and drainage tube care

• Keep your incision areas clean and dry.
• Check your incision areas every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • Warmth.
  • Pus or a bad smell.
• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandages (dressings). If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• If you have a drainage tube, follow instructions from your health care provider about how care for it.
  • Do not remove the tube yourself.
  • Change the dressing around the tube as told by your health care provider.
  • Write down how much fluid drains each day. Note any changes in how the fluid looks or smells.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) for at least 1 week after your procedure, or for as long as told by your health care provider.
• Avoid intense physical activity for as long as told by your health care provider.
• Walk around at least one time a day. This helps to prevent blood clots. You may increase your physical activity gradually as you start to feel better.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions. You may be kept on a liquid diet for up to two days after your procedure, or until you have a bowel movement.
• Drink enough fluid to keep your urine clear or pale yellow.
• Avoid any foods or drinks that cause gas or abdominal discomfort.
• Do not drink alcohol for as long as told by your health care provider. This is especially important if you are taking prescription pain medicines.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• If you have a catheter, follow instructions from your health care provider about caring for your catheter and your drainage bag.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You feel nauseous for more than 2 days after your procedure.
• You vomit.
• You have pain that gets worse or does not get better with medicine.
• You have difficulty urinating.
• You have pain when you urinate.
• You develop a cough.
• You have tenderness or pain in your leg muscles.
• You have not had a bowel movement in more than 2 days.
• You have more redness, swelling, or pain around any of your incisions.
• You have more fluid or blood coming from any of your incisions.
• Any of your incisions feel warm to the touch.
• You have pus or a bad smell coming from any of your incisions.
• You have a fever.
• The amount of blood in your urine increases.

Get help right away if:

• You have chest pain.
• You have severe pain.
• Your catheter has been removed and you are not able to urinate.
• You have a catheter in place and the catheter is not draining urine.