Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain...
Transcript of Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain...
![Page 1: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/1.jpg)
Kaiser Oakland Urology
![Page 2: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/2.jpg)
What is Laparoscopy?
Minimally invasive surgical alternative tostandard surgery
![Page 3: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/3.jpg)
How is Laparoscopy Performed?
A laparoscope and video camera are used to visualize internal organs without a large surgical incisionCO2 gas is used to fill the abdomen to create space in the abdominal cavity for the procedureSpecially designed surgical instruments are used through ports placed through multiple small incisionsSometimes a bigger incision is also made just large enough to remove a kidney if needed.
![Page 4: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/4.jpg)
What are the Advantages of Laparoscopic Procedures?
Faster recoveryBack to workBack to daily activities
Shorter hospitalizationLess post-operative painSmaller incisions – better cosmetic results
![Page 5: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/5.jpg)
Typical Flank Incision used for Standard Nephrectomy
One long incision goes from side to front
![Page 6: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/6.jpg)
Typical Subcostal Incision used for Standard Nephrectomy
![Page 7: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/7.jpg)
Typical Incisions used for Laparoscopic Nephrectomy
LargerIncisionneeded to remove a kidney
Typical Laparoscopic incision
![Page 8: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/8.jpg)
Typical Incisions used for Standard Pyeloplasty (UPJ repair)
![Page 9: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/9.jpg)
Typical Incisions used for Laparoscopic Pyeloplasty (UPJ repair)
Typical Laparoscopic incisions
![Page 10: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/10.jpg)
Laparoscopic Procedures are NOT for Everyone!
Standard surgery may be a better option for some patientsCommon reasons that may make the standard incision surgery a better option:
Previous operationsAbnormal or difficult anatomyComplex surgical problemsSurgical risk
![Page 11: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/11.jpg)
Risks of Laparoscopic Kidney Procedures
InfectionBleeding and blood transfusionLung problemsBowel Problems
Slowed functionsSmall bowel obstruction
Organ injurySmall or large intestineLiverSpleenUrinary tract
![Page 12: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/12.jpg)
Change in Plan -Conversion to Standard Surgery
For successful outcomes or patient safety,laparoscopic procedures may need to be convertedto a standard surgery
Typical reasons for conversions:BleedingUnexpected surgical problemsDifficult anatomySurgical complications
![Page 13: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/13.jpg)
Common Types of Laparoscopic Kidney Surgery
Nephrectomy = total kidney removal Partial Nephrectomy = partial kidney removalNephro-ureterectomy = total removal of kidney and ureterPyeloplasty = repair of UPJ obstruction
![Page 14: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/14.jpg)
Total Nephrectomy
Removal of entire kidneyFor kidney tumors/cancerFor non-functioning kidneys
Moderate size incision is made in the lower abdomen just large enough to remove the kidneyHospital stay: usually about 2 days
Kidney
![Page 15: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/15.jpg)
Nephro-ureterectomyRemove entire kidney and ureterMay require a 2nd incision to remove the lower ureter as it enters the bladderHospital stay: usually about 2 days
Kidney
Ureter
![Page 16: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/16.jpg)
Partial NephrectomyPart of kidney is removed
Kidney tumors/cancerMaximizes kidney function by preserving as much kidney tissue aspossibleRequires some kidney repair or reconstructionHospital stay = usually about 2 days
KidneyKidney Surgery
TumorTumor
![Page 17: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/17.jpg)
Risks of Partial NephrectomyA more complex surgery
Potential for total kidney removalPartial removal may not be safe or possible
Prolonged Urine leakPoorly functioning kidneyHigh blood pressureRecurrent cancer in kidneyHealing complications
Arterio-venous fistulas
![Page 18: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/18.jpg)
UPJ Obstruction Repair
UPJ Obstruction:Obstruction of urine flow from the kidney UPJ Obstruction may cause:
PainUpper abdomenSide of back
Loss of functioning kidney tissueDeteriorating kidney functionKidney stonesSerious Kidney infection
![Page 19: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/19.jpg)
Internal Kidney Anatomy
Ureter
Renal Pelvis
Kidney
“meat” of the kidney filters blood and creates urine
Internal plumbing of kidney drains urine
toward bladder
![Page 20: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/20.jpg)
What is the “UPJ”?
“UPJ”= Ureter and renal pelvis junction
Ureter
Renal PelvisKidney
![Page 21: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/21.jpg)
Typical Causes of UPJ Obstruction
Narrow UPJKinking of UPJby artery to kidney
Kinking of UPJDue to abnormal anatomy
![Page 22: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/22.jpg)
UPJ Repair = Pyeloplasty
Restore the normal drainage of the kidney Remove the narrow segment of ureter if neededRestore the normal anatomy to prevent ureterkinkingMove ureter away from artery if needed
![Page 23: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/23.jpg)
Risks of UPJ Repairs
InfectionProlonged urine leakContinued or recurrent obstruction
Scar tissue/ poor healing
![Page 24: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/24.jpg)
Let’s Get You READY for Surgery!
![Page 25: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/25.jpg)
Review the Oakland Urology Presentation
“Prepare for Your Surgery”
![Page 26: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/26.jpg)
“Prepare for Your Surgery”Presentation
Like this presentation, it can be found on the Oakland Urology Presentations on your Urologist’s KP website
Covers the pre-surgery preparation for urology surgery at Oakland Kaiser
![Page 27: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/27.jpg)
![Page 28: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/28.jpg)
![Page 29: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/29.jpg)
Typical Recovery after Laparoscopic Kidney Surgery
![Page 30: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/30.jpg)
After SurgeryIn the Recovery Room
Expect to stay in the Recovery Room for about 1-2 hours while anesthesia wears offMost patients do not remember much from the operating room due to the sedatives and anesthesia medicinesYou will be comfortable, but groggy!Your Urologist will call your family with a full report
Expect good news!No visitors are allowed in the Recovery Room
![Page 31: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/31.jpg)
What to Expect after Laparoscopic Surgery
Some abdominal discomfortPain medications will be available
Shoulder painFrom CO2 gas. Harmless!
Slow return of normal bowel functionEat smaller and easy to digest meals to avoid:
NauseaBloatingAbdominal Cramps
![Page 32: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/32.jpg)
After SurgeryIn Your Hospital Room
The night after surgery you may get out of bed with nurse assistance, if you wishYour pain should be easy to control with intravenous injections
![Page 33: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/33.jpg)
First Day After Surgery
GoalsPain Control
Pain pills and/or injectionsStart Diet
Start with clear liquidsSlowly progress to solid foods as your digestive system will allow over the next 1-2 days
Start with small and frequent mealsTry easy to digest foods first
Walk at least 4 times dailyYou will need assistance the first time out of bedPrevents blood clotsPromotes strength return
![Page 34: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/34.jpg)
2nd Day After Surgery
Goals:Pain Control
Pain pillsInjections for breakthrough pain
Start DietSlowly progress to solid foods as your digestive system will allow.
Walk at least 4 times daily Learn home care if anyPrepare for going home
![Page 35: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/35.jpg)
Bulb Drains
Commonly used with:Partial NephrectomyUPJ Repair/Pyeloplasty
Drainage bulb may be placed for a few days to collect excessive fluidsHeld in place with small stitch – cut to remove drainUsually removed within a few days when the repaired urinary tract becomes water tight.
![Page 36: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/36.jpg)
Bulb Drain
BulbDrain
![Page 37: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/37.jpg)
Wound CareIf you have a bulb drain…
Change the gauze:If dirty, wet or soiledIf uncomfortable
Do not shower:Sponge bath is OK!
![Page 38: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/38.jpg)
If you go home with a bulb drain
Empty and recharge every 8 hrsKeep a record of the 8 hr output
Measure in ounces or “cc” or “mls”A specimen cup works well for this!
It has measurement lines on the sideYour Urologist will determine when to remove the drain based on your report!
![Page 39: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/39.jpg)
Ureteral Stents
Commonly used withPartial NephrectomyUPJ Repairs/Pyeloplasties
Hollow tube placed in kidney, ureterand bladderAllows urine to drain urine from kidney to bladderAn ureteral stent is used to assure:
Maximum kidney drainageGood position of the ureter ( Pyeloplasty)
Remains in a few weeksRemoved with minor office procedure
![Page 40: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/40.jpg)
Please Review The Oakland Urology Presentation
“Your Ureteral Stent”
![Page 41: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/41.jpg)
![Page 42: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/42.jpg)
Oakland Urology Presentation“Your Ureteral Stent”
![Page 43: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/43.jpg)
Activity Level after Surgery
Individual Recoveries Vary!Walking and stairs:
Even the day after surgery!At least 4 times daily – very important
Return to normal activitiesSelf Care: when you get home!Work
Office work: 2 weeksPhysical labor: 4 weeks
Exercise: 4 weeks
![Page 44: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/44.jpg)
Kidney Tumors Pathology Report
The Pathology report is usually back within 1 week of surgery
The report will tell us:Type of cancer or TumorGrade of the cancerIf the cancer appears to be:
Confined to the kidneyInvolving the surgical marginsSpread to lymph nodes ( if biopsied)
![Page 45: Kaiser Oakland Urology · Hollow tube placed in kidney, ureter and bladder Allows urine to drain urine from kidney to bladder An ureteral stent is used to assure: àMaximum kidney](https://reader031.fdocuments.in/reader031/viewer/2022022118/5cf80a2188c9933f408c95bd/html5/thumbnails/45.jpg)
Questions?
Call our nursing staff or E-mail your surgeonOur nursing staff know the answers! 510- 752-6796
Stephanie Kris Cleo