Before Urological Surgery

In the Days before Your Surgery

  • Please call (310) 423-0790 between 9 a.m. and 5 p.m. any day before your surgery to check in with Admissions.
  • Be sure to tell your doctor if you are currently taking anti-coagulation or blood-thinning medication, such as aspirin, Warfarin, Heparin or Coumadin. These medications should be discontinued 10 days before surgery. However, it is very importnat that you always check with your surgeon as well as the doctor who prescribed your anti-coagulation or blood thinning medications before discontinuing them.
  • You will need a preoperative clearance exam from your primary care physician. He or she will need to perform a history and physical examination within two weeks of your surgery. You will need to have blood and urine tests within two weeks of surgery. You may also need a chest X-ray and/or an EKG and other tests, as indicated by your medical condition.

The Night before Surgery

  • DO NOT eat or drink anything, including water, after midnight the night before you have surgery.

The Morning of Surgery

  • If your doctor told you to take any medication, take it with just a sip of water (just enough to get the pill(s) down).

Please Bring the Following to the Hospital

  • A list of medications you are taking and a description of how often and how much you take (Do not bring the medications with you)
  • Glasses, hearing aids, dentures, a robe, slippers, etc., to make you feel as comfortable as possible
  • A copy of advance directives

Please leave valuable items, such as jewelry, credit cards, wallets or watches, at home.

During Surgery

You may be a little nervous about having surgery. Knowing about what will happen while you are asleep may help calm you down.

How It Begins

After you have been admitted, you will be taken to the pre-op area. Here you will meet with anesthesiologist(s) and nurses who will ask you questions about your medical history. They will answer any new questions that you may have about your hospital stay. Your anesthesiologist will introduce him- or herself at this time and explain how the anesthesia will affect you.

A nurse will then start an intravenous (IV) fluid drip in the vein of your arm. This IV will continuously provide water and nutrients into your system to keep you hydrated. The IV also allows the team to give different medications through one source, rather than having to give a separate injection each time a new medicine is needed.

The Operating Room

Once the IV is in place, you will be taken to the operating suite, where you will be moved to the operating table and given anesthesia. After you go to sleep, a soft tube will be inserted through your mouth and the bronchial tube leading to your lungs to help you breathe more easily during surgery. This is called intubation.

Endoscopic Surgical Procedures

Before the operation begins, you will be placed in the correct position for the procedure you will have. If your operation is to remove stones in the kidney, ureter or bladder, your doctor will send the stones to the laboratory for chemical analysis. The results of the stone analysis will take about 10 days. If tumors are removed, they will be sent out to pathology for analysis.

The surgeon will use a device called a cystoscope (a small camera) to go into the urethra and the bladder. The bladder is inspected for any abnormalities.

A guide wire is placed into the ureter. A ureteroscope (a small tube-like instrument with a camera) is advanced over the guide wire. Some X-rays are taken to show the inside of the kidney and ureter. Then a laser is used to break the stone into many tiny fragments (like sand). A laser will also be used if tumors or strictures exist. A stent is normally placed in the ureter to keep the pathway from the kidney to the bladder open in case swelling occurs during or after surgery.

You will also have a catheter inserted into your bladder to allow urine to flow into a collection bag while you sleep. The catheter may remain in place after the surgery for a short time, until you can move around and urinate on your own.

Percutaneous Surgery

Before the operation begins, you will be placed in the correct position.

The radiologist will establish an entryway (called a tract) into the kidney under fluoroscopic control. This tract is made through a small incision in your back (flank). The surgeon will then use the nephroscope (a small camera which allows the surgeon to see into the kidney) and a laser to break up and remove the stones. A nephrostomy tube remains in the tract after surgery, and a urine collection bag is attached to the tube.

You will also have a catheter inserted into your bladder to allow urine to flow into a collection bag while you sleep. The catheter may remain in place after the surgery for a short time, until you can move around and urinate on your own.

Once all instruments are removed and the surgery is finished, you will be moved to a recovery area known as the Post-Anesthesia Care Unit (PACU), where you will awaken. After the medical team evaluates your status, family members will be permitted to visit.

Laparoscopic Surgery

Basically, there are two types of laparoscopic surgery. One is a procedure in which the entire organ (i.e., kidney, prostate or adrenal gland) is removed. The other is a procedure in which the organ is preserved by removing the cyst, mass, tumor or blockage.

Before the operation begins, you will be placed in the correct position.

X-rays will be taken to show where to make the incisions for the placement of the instruments and camera.

The entire surgery is done through several very small incisions and using a tiny camera. Long, slender instruments free the organ from its connecting tissues and vessels. If the organ is being removed, a larger incision is made for easier removal.

In both types of laparoscopic surgery, part of the tissue will be sent out for analysis/pathology and diagnosis.

You will also have a catheter inserted into your bladder to allow urine to flow into a collection bag while you sleep. The catheter may remain in place after the surgery for a short time, until you can move around and urinate on your own.

Once all the instruments are removed and the surgery is finished, you will be moved to a recovery area known as the Post-Anesthesia Care Unit (PACU), where you will awaken. After the medical team evaluates your status, family members will be permitted to visit.

After Surgery

The nurse will remove your catheter and make sure that you are able to urinate before you go home.

You will need to call the Urology Academic Practice to schedule a postoperative appointment at (310) 423-4700. Your first postoperative visit usually will be in two to four weeks, however your surgical coordinator will arrange your specific postoperative visit based on your surgeon's recommendation.

Remember to arrange for a way to get home from the hospital when you are discharged. The hospital does not provide transportation. The hospital does not allow you to leave the hospital without transportation by a responsible adult.

If you have young children, you may not be able to look after them immediately after your return home. Make sure that you have a childcare plan in place so that you can get the rest you need.

Questions

If you have any additional questions, please do not hesitate to call us at (310) 423-4700.

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