Ureterolysis for retroperitoneal fibrosis

What is this?

This involves freeing the obstruction to the ureters and removing part of the scar tissue; the ureters are usually wrapped in a fatty envelope (the omentum) or synthetic material to prevent further obstruction

What alternatives are there?

Placement of plastic internal stents, diversion of urine using a piece of intestine, steroid therapy

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?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. A long incision in your abdomen is necessary to perform the operation. Both ureters a freed from the scar tissue to relieve obstruction. To prevent a recurrence of the obstruction, the ureters are usually wrapped in fatty tissue from top to bottom. Small catheters or stents will normally be left in the ureter to speed the healing process and to minimise leakage of urine. In some patients, tubes inserted into the kidney through the back (nephrostomy tubes) will also be used; these will usually have been inserted at some stage before the operation to relieve obstruction to the kidneys. A drain is normally inserted into the abdomen and it is usual to require a stomach tube to prevent overinflation of the bowel with air. A bladder catheter is usually inserted at the end of the procedure to monitor urine output from the kidneys accurately.

After the procedure

Initially, you will only be able to take sips of water by mouth or to have ice to suck. This is because any major surgery on the abdomen tends to cause temporary bowel paralysis. Your drain will be removed when drainage ceases, usually after 4-5 days. Any ureteric catheters, stents or nephrostomy tubes may need to remain for a variable period of time, depending on the severity of the original obstruction. The stomach tube is removed when your bowel activity returns and, once it has been removed, you will be allowed to take fluids by mouth, progressing to food If your progress is satisfactory. Your stitches will normally be removed after 10-14 days. The average hospital stay is 18 days.

Potential side effects