Before I start my experience of ureteral reimplantation, I would like to relate my experience of what is known as a;-
Ureteric Meatotomy
Procedure took place last September 09.
I was to undergo a Cystoscopy with ureteric catheterisation including fluoroscopy and ureteric dialation and insertion of stent.
Day procedure Only
Normally done as a day patient, in my case I was admitted to hospital for pain management overnight.
Pain Management
I would have to say having gone through reimplantation later on, this procedure was far worse as far as pain went.
I was totally unprepared for the pain it was as simple as that.
Although I had not been operated on as far as cut open, it was unbearable.
I was given high end drugs, morphine injections etc. Nothing took the edge off the pain or nausea.
After a sleepless, painful night I was released home with medication called Diclofenac Tabs 50mg (Diclohexal). I don’t know what they were supposed to do but it didn’t help at all.
Recovery
It took 2 weeks to recover from this.
Removal of stent and fluroscopy.
October 12th 2009, day surgery Only.
Pretty straight forward under general anaesthetic takes 45 minutes normally
Complications
Stent had moved and could not be retrieved, resulted in complete obstruction of uretera to bladder. It was due to a megaureter, it is very large and floppy. It left too much movement for stent – my opinion only.
CT nephrostomy
As a result of complete blockage, a nephrostomy was preformed using a CT scan to guide specialist.
I was given a local anaesthetic into the left kidney. He inserted a fine tube directly into the kidney and attached drainage bag.
Pain
No pain with this procedure just slight stinging from the local.
Complications
You are monitored closely for urine output, unfortunately for me this took a few hours. (I don’t know why)
Care and management of nephrostomy bag
I was shown how to remove and care for bags and tubes. It was very daunting trying to digest all this especially since it was such a shock that this had happened.
I learnt to take bag off and turn off the tubes to the kidney, to shower and how to attach night bags and leg bags and how to keep everything sterile.
I became quite used to all this and it didn’t worry me at all. Even sleeping was ok.
I must mention though if I did get caught up in the tubes at night, the pain in the kidney was excruciating because all the urine was still collecting in the kidney with nowhere to go. I would gingerly get myself upright and let it drain, the relief was immediate.
Removal of stent through kidney
I was told that I would only have kidney drainage in for a week after which the stent would be removed through the kidney where the drainage tube was attached, and that they would attempted reopen the ureter to the bladder.
Pain Management
This procedure took place at a Diagnosic Imaging centre, where they used ultrasound to guide specialist. I was given a local and was fully awake during the procedure. Pain was bearable up until he came in contact with the bladder. Because the local had no affect here, it was very painful.
This procedure was not successful and I would not recommend it to anyone. I hope they don’t do this one to little ones.
Nephrostomy bag and tubes reinserted and stayed there until reimplantation operation some weeks later.
This took 2 hours of lying still in the one position.
Ureteral Reimplantation
November 23rd 2009
Preop Advice
This time I was given pain management advice from nurses and I was very scared because of the pain of first op. I was told no matter what do not let the pain get above a 4.
The pain system is rated 10 the worse and 1 being no pain. Do not grin and bear it. They advise that it is easier to keep pain at a stable level, than to let it go then relief is nearly impossible.
Day of procedure
The operation takes normally 2 hours
A full general anaesthetic.
Hospital stay 5-7 days
Waking Up
Spent a couple hours in ICU.
Was sent off to ward.
I no longer had a kidney drainage bag hooray!
Pain Management
Having remembered what the nurses said, I was ready for anything.
I had several tubes:
- I had a Foley catheter, adominal drainage tube, canular inserted for anaesthetic now used for pain relief machine and oxygen
- I also had leg compression thingys that blew up and down that was great.
Pain relief via cannular at preprogrammed dosage (so you can’t overdose).
I recommend to everyone to start dosing yourself straight away, don’t wait for pain.
Incision
About 5 inches long from about 2 inches below belly button to half inch into pubic hair.
At this stage the incision was covered with bandages, it was however not stapled or anything and didn’t require any removal. I was told extensive there was stitching internally that would take as long as nine months heal. So be careful.
Getting out of bed
I made sure I was up that day of operation. Had to have tube removed from canular to do so. I made sure I had a bowel movement, I felt fine considering. I found it quite strange though went I did go to toilet,I had no urge to urinate – more on that later.
Eating
I was able to eat anything I liked and I did. I had no nausea, nothing. I was very sore but felt well.
Drainage Tube Removal
Warning on this one.
It was really painful and unexpected. I didn’t have any pain relief and was unprepared. So make sure your prepared for this one: it’s awful.
Hospital Stay
Doc said I could go home on the Thursday I had op on the Monday. I went home with catheter still inserted and had a great weekend at home although painful.
Catheter Removal
I thought this would be painful but it wasn’t. I had to wait until I had voided (urinated) and there had to be no more than 250ml left in bladder. This was measured via ultra sound.
Well, even though I still had 500ml left in bladder after voiding they let me go home.
Pain relief at home
I was sent home with Tramal (Tramadol)which I duly took every six hours on the clock remembering what the nurses had said.
Urinary Retention
Here is when I ran into trouble no matter how much I tried I could not empty bladder. I voided only small amounts at one time. The pain was excruciating. The strangest part was I didn’t seem to get the signal to want to go to toilet, Then it hit me may be it was the medication. I did research on Tramal and found one of the side affects was urinary retention. I informed my Urologist, he did not agree and said if it wasn’t any better the next day that they were going to put catheter back in. I had already stopped this medication and within 12 hours I was urinating normally again and what’s more I was receiving the signals from the brain to do so. So may be I’m wrong and he’s right, but I still believe it was the medicaion
Recovery
I was feeling really well after 4 weeks. I still have a problem with a small area near pubic hair incision not healing as well as it should.
Did it work?
Will let you know in few weeks.
Kidney reflux, ureteral reimplantation surgery and bladder spasms 