Robotic Removal of Kidney and Ureter (Nephroureterectomy) Postoperative Instructions

Clothing

After surgery, your abdomen may be bloated, and it can be difficult to fit into your regular pants. Wear a pair of comfortable pants that have a loose waistband.

After Anesthesia

Do not drive a car or operate machinery for 24 hours after anesthesia. Do not consume alcohol, tranquilizers, sleeping medication, or any non-prescribed medications for 24 hours after anesthesia or if taking prescription pain medication. Do not make important decisions or sign any important papers in the next 24 hours after anesthesia.

Foley Catheter

During surgery, you will have a Foley urinary catheter placed in your bladder. A catheter is a plastic tube that drains urine from the bladder to the outside of your body into a bag. The catheter will stay in place until your body heals. This varies between 7 and 14 days. While the catheter is in, you may notice leakage of urine or blood around the catheter. This may be more noticeable with bowel movement. You may also notice some blood, debris or mucous sediment in the drainage tube or in the bag. The color of the urine may vary. Be sure to drink plenty of water, at least 60 ounces (2 liters) per day.

It is very important to make sure the catheter drains well. The bag should always be lower than your bladder. It is very important that there is no pulling or tugging on the catheter. Keep the catheter well secured to the leg at all times. There should never be any tension or pulling on the catheter. You may use over-the-counter medical tape to secure the catheter if needed. During the day, the catheter can be connected to a smaller bag called a leg bag. A leg bag can be worn under your pant leg. At night, the catheter should drain into a large drainage bag. You will receive instructions about the care of your urinary catheter before discharge from the hospital.

Bladder X-ray (Cystogram)

A bladder x-ray (cystogram) may be performed before catheter removal. Bladder x-rays are typically done in the hospital radiology department the catheter will be filled with x-ray dye. X-ray pictures are taken with dye in the bladder and after the dye has been drained. This is to check that there is no leak after the repair. If a leak is seen, the catheter is typically left in place for another week. A bladder x-ray is often repeated one week later.

Patients often come to our office for a nurse visit after the bladder x-ray to remove the catheter.

Jackson Pratt (JP) Drain

A surgical drain called a Jackson Pratt (JP) drain may be placed after surgery to drain excess fluid and blood from the body. Blood and fluid will leak around the drain. This is expected and is not a cause for alarm. The drain dressing needs to be changed when wet.
It may be removed once the drain output is low, generally less than 60 mL over 8 hour periods. It may be removed before you leave the hospital or in the office a few days later.
If you go home with the drain, secure it by attaching it to your clothes with a safety pin. Place gauze around the drain and secure with medical tape. Gauze and medical tape can be purchased at a drug store without a prescription. Change the gauze daily and as needed once wet.
Keep a record of the amount of drainage every 8 hours. Bring the record to the office for the nurse to review to see if it is safe to remove the drain.

Dressings

Remove all dressings the day after surgery. There are skin staples in each incision. You do not need to place a dressings over the staples. If there is oozing or spotting from the incision, you may place over-the-counter gauze over the incisions. Secure with over-the-counter medical tape. If dressings are placed, change daily. Stop dressings once there is no more oozing or spotting.

Bathing

You may shower daily starting the day after surgery. Let warm soapy water run over the incision and the catheter. Once out of the shower, pat the incisions dry. Do not take baths or submerge in water until your catheter has been removed and your surgical sites have healed.

Medications

Resume your regular medications or follow instructions given at the hospital.

A pain medication to be taken by mouth may be prescribed for you. Narcotic pain medications are addictive and constipating and therefore should be discontinued as soon as possible.

NSAIDs (Alleve, ibuprofen, Motrin) decrease pain and inflammation. These may be prescribed or can be purchased at a drug store without a prescription.

Acetaminophen (Tylenol) helps decrease discomfort after surgery. This is available at any drug store without a prescription. Some narcotic pain medicines also contain acetaminophen. Do not take more than 3000 mg acetaminophen total per day. Ask your medical provider if you have history of liver problems.

A stool softener should be taken by mouth twice a day to avoid constipation. Constipation can cause you to strain to have a bowel movement, which puts stress on the surgery site and can impair healing. A stool softener or laxative may be prescribed or is available at any drug store without a prescription. These include Senna or Senokot or SennaGen, Dulcolax or Bisacodyl, Milk of Magnesia or magnesium hydroxide. Decrease or stop the stool softener for loose stools or diarrhea. Take stool softeners by mouth only. Avoid suppositories or enemas unless directed by your physician.

An antibiotic may be prescribed for you to take by mouth. Take this one hour before catheter removal.

Ditropan or oxybutynin (an anticholinergic) may be prescribed for you to take by mouth for bladder spasms. This is also available over the counter as Oxytrol patch and may be used in men and women. Stop this medication 24 hours before catheter removal.

Activity

Get up and walk at least six times daily starting the day after surgery. You may be up and about as much as you like. You may go up and down stairs. You may take walks outside. Gradually increase the amount you walk each day.

Do not drive while the catheter is in place or if you are taking narcotic pain medicine.

Do not lift more than 10 pounds (4.5 kilograms) for 6 weeks. Do not bicycle or ride a motorcycle, tractor or horse for six weeks.

You may tire easily with minimal activity and find that you require an occasional nap. Your energy will return over the course of weeks to months.

Diet

Anesthesia and pain medicine can cause nausea and decrease your appetite. Start with clear fluids and bland diet. You may resume your regular diet as your appetite returns. Be sure to drink plenty of water, at least 60 ounces (2 liters) each day. Be sure to eat plenty of vegetables and fruits to promote healing and avoid constipation.

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