Open reconstruction of the kidney pelvis

What is this?

This involves repair of narrowing or scarring at the junction of the ureter with the kidney pelvis (the pelvi-ureteric junction) and insertion of a temporary stent or kidney drainage tube to aid healing

What alternatives are there?

Observation, telescopic incision, dilatation of the area of narrowing, temporary placement of a plastic tube through the narrowing, (telescopic or minimally-invasive) repair.

What to expect before procedure

You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. The kidney is usually approached through an incision in your loin although, on occasions, the incision is made in the front of the abdomen. A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is usually placed through the skin into the bed of the kidney. It is normal to insert either a second drainage tube into the kidney itself or a ureteric stent to allow healing of the reconstruction.

After the procedure

You will be mobilised as soon as possible after the operation to prevent deep vein thrombosis. Physiotherapy will also be provided to help you mobilise and to aid your breathing & coughing. One drainage tube is removed once drainage from the renal bed has ceased, usually after 3-4 days. The catheter will be removed from your bladder when you are mobile enough to get to the toilet to pass urine. The second drainage tube (into the kidney) is normally removed after 8-10 days; it is usually clamped for 24 hours before removal and, occasionally, an X-ray is performed along the tube to ensure healing is complete before it is removed. You may be discharged before this tube is removed and brought back to the ward briefly for it to be clamped at a later stage. If a stent has been inserted during the procedures, this will normally be removed at a later stage as an outpatient procedure. The average hospital stay is 6 days.

Potential side effects