During your initial consultation with your surgeon, he or she will review your medical history as well as any outside reports, records and X-ray films (e.g., CT scan, MRI, sonogram, renal scans, etc.).
A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for surgery, you will then meet with a patient service surgery coordinator to arrange for the date of your operation.
Note: It is very important that you bring all of your X-ray films and reports to the initial consultation with your surgeon.
What to Expect prior to Surgery
Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.
These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was sent.
Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:
- Physical exam
- Electrocardiogram (EKG)
- Complete blood count (CBC)
- Blood coagulation profile (PT/PTT)
- Comprehensive metabolic panel (blood chemistry profile)
Preparation for Surgery
Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, 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.)
Bowel preparation and clear liquid diet
Drink one bottle of magnesium citrate, which you can purchase at your local pharmacy, the evening before your surgery. Do not eat or drink anything after midnight.
Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.
Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through. Please follow the diet below.
- Clear broths (no cream soups, meat, noodles, etc.)
- Chicken broth
- Beef broth
- Juices (no orange juice or tomato juice)
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Tea (you may add sweetener but no cream or milk)
- Coffee (you may add sweetener but no cream or milk)
- Clear Jell-O (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (not marshmallow)
During Your Hospitalization
Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.
- Hospital stay: The length of hospital stay for most patients is approximately one to two days.
- Diet: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated until you are able to tolerate a diet; it also provides a way to receive medication). Most patients are able to tolerate ice chips and small sips of liquids the day after surgery and regular food the next day. Once on a regular diet, pain medication can be given by mouth instead of by IV or shot.
- Postoperative pain: Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) administered by the nursing staff. You may experience some minor transient shoulder pain (one to two days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery.
- Nausea: You may experience some nausea related to the anesthesia or pain medication. Medication is available to treat persistent nausea.
- Urinary catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while you are asleep) for approximately two days after the surgery. It is not uncommon to have blood-tinged urine for a few days after surgery.
- Drain: You will have a drain coming out of a small incision in your side. This drain is placed in the operating room around the operative site to prevent blood and fluid from building up around the kidney and pyeloplasty repair. The drainage typically appears blood-tinged. It is usually removed the day the urinary catheter is removed. If persistent high-volume drainage occurs, you may have to go home with the drain and have it removed in your doctor's office.
- Fatigue is common and should subside within a few weeks following surgery.
- Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by 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 after your surgery it is very important to get out of bed and begin walking under the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have sequential compression devices (SCDs) along with tight white stockings to prevent blood clots from forming in your legs.
- Constipation/gas cramps: You may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation, and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.
What to Expect after Discharge from the Hospital
- Pain control: You can expect to have some pain that may require pain medication for up to a week after discharge. Tylenol should be sufficient to control your pain.
- Showering: You may shower after returning home from the hospital. Your wound sites can get wet but must be padded dry immediately after showering. Tub baths are not recommended in the first two weeks after surgery as this will soak your incisions and increase the risk of infection. You will have adhesive strips across your incisions. They will fall off in approximately five to seven days on their own. Sutures underneath the skin will dissolve in four to six weeks.
- Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible but should be taken slowly. Driving should be avoided for at least one to two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) until instructed by your doctor. Most patients return to full activity on an average of three weeks after surgery. You can expect to return to work in approximately two to four weeks.
- Follow-up appointment: You will need to call the Johns Hopkins Outpatient Urology Clinic at 410-955-6707 after your surgery to schedule a follow-up appointment as instructed by your surgeon.
- Stent follow-up: The stent will remain in place for approximately one month and will then be removed in the doctor's office through a cystoscope (a small telescoped passed down the urethra to retrieve the stent). It is not uncommon to feel a slight amount of flank fullness and urgency to void, which is caused by the stent. These symptoms often improve over time.
Professor of Oncology
Executive Vice Chairman, Department of Urology
Director of Adult Urology
Director, Minimally Invasive and Robotic Surgery
To make an appointment for consultation, please call 410-955-6100.
In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 for The Johns Hopkins Hospital or 410-550-0100 for Johns Hopkins Bayview Medical Center and ask to speak to the urologist on call.