Ureterolysis - Kicks off the Block

What Is Ureterolysis?

The ureters carry urine from the kidneys to the bladder. However, pressure from a scar or mass of tissue can block one or both of the ureters. This causes urine to build up in the kidneys rather than flow out of the body. Ureterolysis is a procedure that aids in treating this problem. With this surgery, the ureter is released from the tissue pressing on it. The ureter is then shifted to a new position away from the blockage.

The surgery can be done through various small incisions (laparoscopy), or it can be done through one larger incision (open surgery). Laparoscopy cannot be used in all possibilities. In some cases, the surgeon can start the surgery with laparoscopy but then change to open surgery for safety reasons.

Laparoscopy - The surgeon creates several small incisions in the abdomen. The scope is positioned through one of the small incisions. This sends images from inside the belly to a video screen. Surgical instruments are placed through the other incisions. The surgeon can use a method called robotic laparoscopy. The robotic system gives a 3-D (3 dimensional) picture of the body. It also aids the surgeon’s hand movements.

Open Surgery - One larger incision is made in the belly. The surgeon looks and works through this incision.

What Is the Procedure for the Surgery?

First, inform the surgeon about all the medicines. This includes prescriptions and medicines that include herbs, vitamins, and other supplements. It also includes blood thinners, such as Warfarin, Clopidogrel, or daily Aspirin. One may need to stop taking some or all of them before surgery, as directed by the surgeon.

Following any directions that are given for not eating or drinking before the surgery is necessary. If medications have been prescribed, take them with a small sip of water.

A special liquid or medicine is given to take the day before the surgery. This is to make sure that the colon is empty for the surgery.

On the Day of Surgery -

The surgery can take about three to six hours. The hospital can last for one to three nights afterward for recovery.

Before the Surgery Begins -

• An intravenous line is placed in a vein in the arm or hand. This is done to provide fluids and medicines such as antibiotics. It can also include medicine to prevent blood clots.

• General anesthesia is given before the surgery for a pain-free procedure. This medicine induces sleep throughout surgery. In addition, a tube can be put into the throat to help to breathe.

• An epidural to help control post-surgery pain is also given. A small tube is placed into the back to deliver painkillers that numb the lower body. A thin catheter is placed into the bladder to drain urine.

During the Surgery -

• One or more incisions are put together to get to the ureters. The number of incisions depends on the mode of surgery being used. The ureter is released from the tissue around it.

• The reason for the blockage is removed, if possible. This may contain removing scar tissue or a mass that’s pressing on the ureter.

• The ureter is shifted to a new position that lets it drain better. It is secured in place with stitches (sutures).

• A thin tube (stent) may be positioned in the ureter as it heals. The stent enables the ureter to widen so urine can flow through it correctly.

• If required, treatment is also done on the other ureter.

• When the surgery is accomplished, all tools are removed. All the incisions are closed with stitches or staples. In some cases, surgical strips, glue, or surgical tape are used instead.

• A small tube (drain) is positioned near the incision. This drains the fluid that tends to build up after the surgery.

Recovering in the Hospital -

After the surgery, the patient is taken to a recovery room. There they will be watched while waking up from the anesthesia. The patient may feel sleepy and nauseated. If a breathing tube is used, then the throat may be sore at first. When the patient is ready, he will be taken to the hospital room. While in the hospital:

• The patient will get medicine to handle pain. Let the physician know if the pain is not controlled.

• The catheter and drain are possibly removed before returning home. If not, then instructions are given showing how to care for them at home.

Recovering at Home -

After the hospital stay, the patient will be released to an adult family member or friend. The patient must have someone stay with them for the next few days to help care for them. Healing time varies for each person. Then, the physician will inform the patient when to return to the normal routine. Until then, following the instructions that have been given is necessary.

• Take all medications as prescribed.

• Care for the incisions as advised.

• Follow the physician's guidelines for showering. Do not take a bath, swim, use a hot tub, or do other things that will cover the incision with water until the physician says.

• Do not lift anything hefty or do strenuous activities, as directed.

• Do not drive until the physician says to. When taking medications that cause sleepiness or drowsiness, avoid driving.

• Walk a periodic time daily. Increase the pace and distance.

• Do not push to pass stool. If required, take stool softeners as directed by the healthcare provider.

• Drink plenty of water to prevent urine odor and fluid loss (dehydration). And follow any other diet instructions given by the physician.

• If stents were placed in the ureters, a feeling or urge to pass urine is more often. There may also be some burning and blood in the urine, which is normal. It will go out once the stents are removed during a follow-up visit.

When to Seek Medical Help?

Seek medical help right away if any of the following happens -

• Chest pain.

• Fever of 100.4° F (38°C) or higher, or as directed by the physician.

• Hematuria with clots.

• Symptoms of infection at an incision site (like increased redness or swelling, warmth, worsening pain, or bad-smelling drainage).

• No urination for four hours or trouble urinating.

• Pain that cannot be controlled with painkillers.

• Nausea or vomiting.

• Leg pain.

• Swelling or inflammation.

• Trouble breathing.

What Are the Risks and Possible Complications of Ureterolysis Surgery?

Possible risks of the ureterolysis procedure include -

• Infection.

• Bleeding (that can require a blood transfusion).

• Blood clots.

• Urine leakage from one or both ureters.

• Scarring or blockage of one or both ureters.

• Damage to the bladder, kidney, bowels, or other organs.

• Risks of anesthesia.

Conclusion:

Ureteral obstruction due to idiopathic retroperitoneal fibrosis is an occasional but severe clinical situation. There are open approaches, as well as surgical techniques used to prevent stenosis recurrence. Ureterolysis is the only procedure to relieve ureteral obstruction. The ureter is examined and released from the fibrotic process and then separated to prevent the recurrence of the stenosis. Lately, the development of laparoscopic urology has authorized minimal invasive treatment of many urological problems. The technique of ureterolysis for extrinsic ureteral obstruction can be applied.