WHAT TO EXPECT PRIOR TO THE PROCEDURE
Your Coordinator will arrange for your pre-admission testing.
Tulane University Medical Center
Pre-Admission (3rd floor of Hospital)
1415 Tulane Avenue
New Orleans, LA 70112-2699
Tel: (504) 988-5800 or 800-988-5800
Fax: (504) 988-5393
Your personal physician may arrange for your pre-admission testing.  These results need to be faxed at least 7 days prior to your surgery. See fax numbers above.
To assure your safety to undergo the procedure, the following tests need to be performed:

1. Physical exam (Medical Clearance / Cardiac Clearance)
2. EKG (electrocardiogram)
3. Chest X-Ray
4. CBC
5. PT /PTT
6. Comprehensive Metabolic Panel (SMA-12)
7. Urinalysis & Urine Culture

PREPARING FOR THE SURGERY

1. Drink clear fluids for a 24-hour period prior to the date of your surgery (please see attachment 1, Clear Liquid Diet).
2. Do not eat or drink anything after midnight the night before the surgery. Drink 1/2 bottle of Magnesium Citrate, which is a laxative (and can be purchased at your local pharmacy) the evening before your surgery.
3. Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Voltaren, Plavix and some other arthritis medications can cause bleeding and should be avoided one 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.

 

 

 

 

POTENTIAL RISKS AND COMPLICATIONS
Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. Potential risks include:

1. Bleeding: Blood loss during this procedure is possible and a transfusion is necessary in approximately 20% of patients. If you are interested in autologous blood transfusion (donating your own blood) you must make your surgeon aware.
2. Infection: All patients are treated with antibiotics to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery including fever, drainage from the incision, urinary frequency/discomfort, pain (or anything that you may be concerned about) please contact us at once.
3. Tissue /Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, lung, pancreas and gall bladder may occur requiring further surgery. Loss of kidney function is rare but is a potential risk. Scar tissue may also form in the kidney or ureter requiring further surgery.
4. Conversion to Open Surgery: This surgical procedure may require conversion to the standard open operation if difficulty is encountered during the procedure. This will result in a larger open incision and possibly a longer recuperation period.
5. Failure to Remove the Stone: There is a possibility that the stone may not be able to be removed due to its size or the location at the time of surgery. Alternative treatment may be required.

WHAT TO EXPECT AFTER THE SURGERY
Immediately after the procedure you will be taken to the recovery area and transferred to your hospital room once fully awake and your vital signs are stable.

1. Post Operative Pain: Pain medication can be administered to you via Patient Controlled Analgesia or PCA (Whereby you as the patient control the administration of your own pain medication by pressing a button) or by an injection given to you by the nursing staff. Your preference will be discussed with you ahead of time by an anesthesiologist.
2. Nephrostomy Tube: You can expect to have a small narrow hollow tube coming out of your back to allow urine to drain from the kidney into a drainage bag. This drain usually remains in place for two days. There is a possibility that you will be discharged from the hospital with a nephrostomy tube.
3. Stent: You may have a ureteral stent (a very thin, hollow tube) in place to promote drainage from the kidney to the bladder (the reservoir that holds urine).

1. Nausea: You may experience some nausea related to the anesthetic. Medication is available to treat persistent nausea.
2. Urinary Catheter: You can expect to have a urinary catheter (a narrow hollow tube inserted into the urinary passage to drain your bladder) for approximately one day after surgery. It is not uncommon to have blood-tinged urine for several days after surgery.
3. 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 enabling you to 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 on the first day and regular food by day two. Once on a regular diet, pain medication can be given by mouth instead of by IV or injection.

•     Fatigue: Fatigue is common and should subside in a few weeks.
•   Incentive Spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections through using an incentive spirometry device. (These exercises will be explained to you during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help prevent pneumonia and other pulmonary complications.
•   Ambulation: On the day of your procedure it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs.
•     Hospital Stay: The length of hospital stay for most patients is approximately three to four days.
•     Constipation: You may experience sluggish bowels for several days or weeks.
      Suppositories and stool softeners are usually given to help with this problem. Taking mineral oil at home and eating plenty of fruits and vegetables will also help to prevent constipation.
•    Secondary Procedures: Some patients have stones that are very large or that cannot be safely removed during the first procedure. You may need a "second look" to remove any remaining stone burden. This may be done during the current hospitalization or at another time.

 

 

 

WHAT TO EXPECT AFTER DISCHARGE FROM THE HOSPITAL

 

1. Pain Control: You can expect to have some pain that may require pain medication for a few days after discharge, and then Tylenol should be sufficient to control your pain.

 

1. Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided.

       Climbing stairs is allowed. Driving should be avoided for at least 1-2 weeks after surgery. Activity can begin as tolerated. You can expect to return to work about two weeks after surgery or as instructed by your physician.

1. Follow-up Appointment: Please call after your discharge to schedule a follow up visit for one week after your surgery date.

 

1. Stent follow up: If you have a stent in place, the length of time the stent remains in place is variable. Your doctor will probably request it to be removed within a 2-6 week period. This can be removed in the doctor's office. It is common to feel a slight amount of flank fullness and urgency to void, which is caused by the stent. These symptoms often improve over time if the stent is left in place for a while.

1. Nephrostomy Site Care: It is important that urine flow freely through the tube.  Check daily to make sure the tube is not kinked. Make sure the stopcock, if present, remains in the open position to allow urine to drain. Keep the tube secure using folded 4x4 dressings around the tube, in a picture frame fashion (see diagram 1). Start with the folded gauze pad underneath the tube, for support and then continue around the tube with the folded sides facing the tube to support it. Place one 4x4 gauze pad on top and then secure the tape over this pad. Secure the tubing to your leg if open to drainage, leaving enough slack on the tube to prevent dislodgement of the tube upon movement. Monitor the amount of drainage, color and odor. Blood-tinged urine is not uncommon. Keep the drainage bag below the level of the kidney to promote gravity drainage. It is important to clean the area around the insertion site with hydrogen peroxide each day during your dressing change. You can shower with the dressing on, and then change it after the shower. You will need assistance in doing this dressing change.

 

1. Tubes open to drainage: If you experience any pain, fever, chills, or lack of drainage from the tube while you are open to a drainage bag, contact your physician immediately. Some yellowish material around the tube is normal, as this is the body's reaction to the tube. If the drainage is foul-smelling or looks like "pus", contact your physician or nurse.

 

 

1. Clamped tubes: If you experience any pain, fever, chills, or leakage around the tube, open your nephrostomy tube immediately to the drainage bag provided to you prior to leaving the hospital. If the urine drains, and the pain and fever subside, leave the tube to drainage and notify your physician or nurse. If the tube does not drain and your symptoms persist you may need to be seen on an urgent basis to have the tube flushed. Again, notify your physician or come to the emergency room. If there is any foul­ smelling drainage around the tube site, let us know, as this may be the sign of a local infection. Some drainage is normal.