Your friends at Patient Action are so sorry that you have been suffering with kidney stones (renal calculi) and that you now require a surgical procedure to remove them. We know how excruciatingly painful kidney stones can be. This information will help prepare you for your operation…. both physically and mentally. It is our hope that this information will empower you to advocate for yourself in achieving a quicker and less complicated surgical recovery. We wish you all of the best for a complete and speedy recovery as you embark on this journey towards wellness.
The surgery is performed by a Urologist via the use of a cystoscope. A cystoscope is a device used to visualize the interior of the urinary system. There is no cutting or suturing with this procedure. The cystoscope is inserted through the urethra while you in an anesthesia-induced sleep in the Operating Room. The urethra is the tube through which urine leaves the body. Once the stone is removed, a temporary stent is generally inserted into the ureter which is the tiny tube through which urine flows from the kidney to the bladder. The purpose of the stent is to prevent your ureter from collapsing as a result of the trauma associated with the removal of the stone and subsequent inflammation. The stent may cause some discomfort and limit your movement, but it will be nothing compared to the pain you experienced while trying to pass the stone. It may protrude from your urethra and this is nothing to be alarmed about. Your doctor will give you pain medication to help you cope with any discomfort. The stent will be kept in from 5 days to 2 weeks depending on your individualized situation. You may be also be discharged with an indwelling urinary catheter hooked up to a urine drainage bag. Most patients say that this catheter is not painful but can be annoying. If you do require one, you or your advocate will be taught how to care for it before you leave the hospital. You will also know what arrangements have been made for having the stent removed, which is a 10-15 minute procedure. Your catheter willbe removed at the same time. BE SURE YOU ASK YOUR DOCTOR TO GIVE YOU SOME SEDATION if the removal is being performed at your doctor’s office. They put you to sleep to insert the stent, be sure they sedate you to remove it! Some doctors will even take their patients back to to Operating Room and put their patients to sleep for the removal. TALK TO YOUR DOCTOR before the procedure… so you both know what to plan for. If your urologist refuses to sedate your for the removal of your stent, ask your Primary Doctor for a pressription. As a last resort…you may want to switch to urologist who will give you some sedation.
PRE-OPERATIVELY:
Make plans to have someone who can drive accompany you to and from the hospital on the day of surgery.
Make plans to have someone who is physically able to help you stay with you during your first few days post procedure, especially if you have small children that need to be physically picked up.
It’s nice to have someone there to answer your phone calls or the door bell, if you drop something, or if something heavy has to be lifted. It’s especially nice to have someone prepare your meals and to cater to you in other ways during those few days post op.
If you can’t get someone to stay with you, you can prepare yourself by freezing some meals which can be easily zapped in the microwave as the need arises. Have small containers of cereal, milk, yogurt, cheese crackers, pretzels, etc available. If you are alone, put non-perishable items and bottled water in a container/cooler and leave near where you will be spending most of your time until your stent is removed. Put bottled water in the refrigerator or small containers of other liquids you enjoy. Have your spouse, significant other or child prepare your lunch and beverages and put in a cooler so you have easy access.
Prepare to have paper plates, cups and plastic silverware accessible if you will be alone post op. You won’t have to worry about washing any dishes.
Make sure you have a phone to keep nearby (ie a cordless phone) or hook your phone up to an answering machine so you can retrieve messages.
Get the book or magazine you’ve been wanting to read. Reading helps to pass away the time while you are home.
Have a radio and/ or TV (with remote!) nearby where you will be spending your post-procedure days. It helps pass the time.
Have a notebook so that you can write down the names of those who sent you gifts, flowers, meals, etc; or who visited you so that you can send them a thank-you note later on. You may also use this notebook for journaling your thoughts. It’s very useful to write down things that you are grateful for each day- it takes the emphasis away from feeling sorry for yourself to being grateful each day.
Let everyone important to you know about your procedure in advance. Tell them the exact date and time of the operation and ask them to send you loving and positive thoughts and prayers at the very moment you will be having your procedure. This includes your clergy.
If anyone asks you how they can help, ask them to bring over a dinner that you can put in your freezer for when you come home. Or ask them if they will be able to drive you to the doctor, the store or to run errands for you.
Learn to ask others for help. When people ask what they can do for you, let them know exactly what you need. Make a list of the names and phone numbers of people who offer to help and keep it handy.
Buy some lavender oil. Research shows that the fragrance of lavender sends a calming message to the brain which counters adrenalin-producing stress signals. Lavender can be purchased in many retail stores.
Put all of the personal items you use on a daily basis in an open container in your bathroom for easy access.
Make a pile of clothing that you will be wearing for a few days until you have the stent removed. Prepare socks that are easy to put on, slip-on shoes/sneakers, loose elastic wide pants or shorts (or skirts for women) to accommodate the indwelling catheter tubing you may be sent home with. It’s a lot easier than having to go into your closet or dresser each day. It might be easier to wear a bathrobe those few days and not try and manipulate putting on pants.
Prepare a pile of thank you cards and stamps so that you can start writing them when you have the energy.
If you have no one to shop for you after your procedure, fill up your pantry, freezer and refrigerator with desired and necessary items ahead of time.
If you normally take medications each day, make sure you have enough to get you through your few days post procedure period. Buy a pill box that will allow you to prepare your meds in advance for a 1 week period so that they will be easily accessible to you. If you don’t have to worry about small children getting into your medications, ask the Pharmacist for tops that are EASILY OPENED.
Ask your doctor if he will be willing to give you your prescriptions for post-procedure medications a day or two before so that you can have them in the house upon your arrival home from the hospital. This is a good time to talk to him about medication for the post procedure office visit during which time the ureteral stent will be removed through the use of a cystoscope. Not every doctor will prescribe anything for this part of the process. However, ask your doctor for at least 10 mg of Valium to take when you arrive at the office. It will take the edge off of the anxiety associated with the process. If he offers you something stronger, take it! If he refuses to give you anything, you may want to go to another doctor. Be sure to have someone with you to drive you home.
Discuss post-op bowel function with your doctor, ESPECIALLY if you tend to be constipated. Find out what you can use and use it!
THE DAY OF SURGERY:
Bring a tooth brush, toothpaste, a hair brush, and a clean pair of underwear if you might be spending the night in the hospital. Plan on wearing home the same clothes you wore to the hospital. Be sure the clothes are large and baggy to accommodate the possibility of an indwelling catheter being inserted for a few days post-procedure.
You will be admitted to a pre-op area where you will be assigned a nurse who will admit you. An Intravenous (IV) will be started. You will be seen by the anesthesiologist and a nurse anesthetist. Be sure to tell him/her if you have any neck or back problems so that extra attention will be paid to the positioning of your body during the operation. Your Procedural Sedation will probably be started through the IV before you are taken to the operating room.
If you feel really nervous, put some lavender oil on your forearm and take a big whiff of its fragrance. Do some deep breathing- breathing in through your nose and out through your mouth. Continue to use your lavender as needed. Stroke a drop of it over your temples to reduce tension headaches; massage a drop across your throat to calm tickly coughs; place a drop on the pillow to relieve insomnia. Put some on your forearm so that you can keep smelling it to reduce stress.
If you are so inclined, ask your doctor/nurse/family to say a prayer with you.
Your throat may be sore after surgery. This soreness is due to the breathing tube they insert into your throat during surgery while you are asleep (don’t worry! it will already be removed by the time you wake up). Your doctor/anesthesiologist can order a throat spray if the soreness is very uncomfortable.
Don’t be afraid to ask questions. Write them down so you won’t forget to ask them when you see your doctor.
Be aware of the role of hand washing in controlling infection. Wash your hands frequently and make sure your health care team washes their hands before touching you! Don’t be afraid to remind them to do this. This is the standard of care in any health care setting.
Don’t be afraid to cough – coughing is good post-op – it reduces your risk of pulmonary complications, such as Pneumonia.
Don’t be afraid to get up and walk post-operatively (as long as you don’t feel too weak or dizzy). Walking prevents post op complications, such as blood clots. Ask for assistance if necessary.
Don’t go home without discussing post-op bowel function with your doctor, ESPECIALLY if you tend to be constipated. Find out what you can use and use it!
If you are hospitalized, plan to take your last dose of pain medication about 45 minutes BEFORE you leave the hospital for home. It will help ease the discomfort during the ride home.
IF YOU WAKE UP FROM SURGERY WITH A URINARY TUBE AND DRAINAGE BAG:
Many patients require the insertion of a urinary tube (through the urethra into the bladder) attached to a drainage bag during the surgical procedure. If it is necessary for you, your doctor will explain why it was needed as soon as you are awake enough to understand. If you do have to go home with a urinary tube and bag, make sure you or your advocate obtain all of the instructions necessary for the care of this urinary drainage system from the Recovery Room nurse before you are discharged. Let the nurse watch you practice the few things you will need to do until you feel comfortable doing them. DO NOT LET THEM RUSH YOU OUT UNTIL YOU FEEL COMFORTABLE CARING FOR THE TUBE AND BAG:
This care includes:
- Emptying the bag when it gets full of urine
- Never raising the bag above the level of your bladder
- Changing from the larger bag to a bag that is worn on the leg for ease in walking
- Cleaning the catheter tube
- Removing and replacing the Velcro strap or piece of tape that holds the tube in place on your thigh
- Instructions on what to do if you have bleeding in your urine
ONCE HOME:
Make sure you show up to all of your doctor appointments and make sure to follow all of your doctor’s recommendations.
Do not lift anything greater than 10 pounds
DRINK DRINK DRINK! The drinking of water is critical to your well-being during this entire time period and towards the reduction of future kidney stones. During the immediate post op period, it will cut down on blood clots, keep your urine clear, and help in the healing process. Three (3) quarts or liters of fluids each day is desirable.
If possible (or desirable), sleep alone the first week so you have the full space in your bed to get yourself comfortable.
Pain Management: Take your pain meds as prescribed. Make sure you have a clock, your pain medication and water nearby wherever you are so that you can keep on top of your pain medication at all times. You may want to set your alarm so you can take your pain medication during the night. Time your pain medication so that you take it about 45 minutes prior to any outings that you might have to go on. DO NOT drive or operate any dangerous equipment/machinery while taking pain meds.
In addition to having some blood and some small blood clots in your urine during the first few week or two post op, you may also have some bloody discharge from the urethra. This is normal, but may become a nuisance. Put a protective cloth underneath you on your bed, chair, couch, etc to protect it from being stained. An inexpensive flannel backed vinyl tablecloth works great for this purpose and it can be washed in the washing machine and hung to drip dry. Ladies and gentlemen may both use feminine mini/maxi pads in your underwear to protect underwear and clothing from getting stained. It is suggested that dark colored underwear be worn during this period. Let your doctor know if this spotting becomes heavier or if it persists for more than 2 weeks.
Some males experience intermittent discomfort in the tip of the penis for a few weeks post op. This is normal and will go away on its own. Let your doctor know if this discomfort lasts for more than one month.
Penile ejaculation will not cause any increased discomfort during the first few weeks post op. However, do avoid penile penetration if you are having any leakage from the tip of your urethra.
SHOWERING: If you are very uncomfortable or feel weak, bring a plastic chair into the shower that you can sit on. Be sure it is a sturdy one- you don’t want to have any accidents in the shower. A hand held shower nozzle is great during the first few days post op.
Some patients find sitting up uncomfortable while the stent is in place. You may be more comfortable lying down.
Make a list of any questions you might want to ask your doctor at your post-op visit to have the stent removed, which usually takes place within 5-14 days after surgery. ASK YOUR DOCTOR TO PRESCRIBE SOMETHING FOR YOU TO TAKE PRIOR TO THE REMOVAL OF THE STENT. If you feel very anxious during the procedure to remove your stent, do some deep breathing – breathing in through your nose and out through your mouth. Plan to take your pain medication about 45 minutes prior to the time of the stent removal. Take a whiff of lavender to relax you. Invite your spouse or significant other to accompany you for the stent removal procedure. It’s nice to have a loved one there for support and tenderness. Better yet, ask your doctor to put you to sleep for the removal of the stent.
IF YOU ARE DISCHARGED WITH A URINARY TUBE AND DRAINAGE BAG:
When your urinary tube was inserted in the hospital, a small band around the tip of it was inflated with water so that the tube will stay in place in the bladder and will not ” fall ” out on its own. The tube can, however, be forcibly pulled out and so you need to be careful that this doesn’t occur, especially when you are changing position in bed or getting dressed. Checking the Velcro thigh band for secure holding of the tube will help prevent the tube from being pulled out. DO NOT PANIC if the tube is accidentally pulled out. It is not life-threatening! You should, however, call your doctor immediately if this happens.
Check the drainage tubing frequently to make sure it doesn’t have any kinks in it and that you see urine draining in the tube. Check the bag frequently. Normally, adults make 1 to 2 quarts ( 1-2 liters) of urine each day. Since you will be drinking a minimum of 3 quarts of water each day, your bag should be filling up several times during the day. If you see little or no urine draining CALL YOUR DOCTOR IMMEDIATELY!
Check the urethra around the tube insertion site for any signs of inflammation. If you have moderate to severe pain, notice any redness, swelling, or pus-like discharge, call your doctor immediately.
Make sure the Velcro band around the thigh that holds the tube in place is not too tight.
PREVENTING URINARY INFECTION: People who have cystoscopic surgery and those with urinary drainage tubes are at a much greater risk for developing urinary infections. If you are discharged with a urinary bag, when you arrive home tie a 30 ” ribbon to the bag so that when you walk, you can use the ribbon to hold the bag (like holding a leash). It is VERY IMPORTANT that the bag is always kept BELOW THE LEVEL of your belly whether you are sitting, standing or lying. This will prevent old urine that is in the bag from re-entering the bladder and possibly causing a bladder infection. You will be taking antibiotics for a few days post op to prevent such an infection. If you notice any of the following symptoms, let your doctor know immediately as you might have a bladder infection:
- fever
- lower abdominal pain
- pain around the urethra
- cloudy, bad-smelling urine
- sweats
- back pain
- shaking chills
Place a small towel under the urinary drainage bag on the floor when you are not moving around just in case there is some leakage from the bag.
When the urinary drainage bag gets full you will need to empty it. Because you are to drink lots of fluids, the bag may need to be emptied several times each day. Use any disposable container you might have in your home in which to empty the bag or you can dump the urine right into the toilet. Be sure to secure the locking clip on the drainage end of the bag’s tube so that it will not leak. Clean the end of the small drainage tube with alcohol before inserting it back into its pocket to keep it clean. Your doctor will let you know if he wants you to measure and record your urine output before disposing of it.
**BE SURE YOU WASH YOUR HANDS BEFORE AND AFTER EMPTYING THE BAG. This will prevent you from introducing bacteria into the bag and will make sure you don’t get infected from dirty urine. If you have disposable latex gloves in the house you can use them for this purpose. Be sure to wash your hands after emptying the bag even if you wear gloves.
**Try to assess the color of the urine each time you empty the bag. Your urine has probably been bloody and may even have some blood clots in it. When the urine starts to turn clear again, this is a good sign! KEEP DRINKING!
SHOWERING with the urinary tube and bag: You probably won’t want to get the Velcro band holding your tube in place wet. CAREFULLY and GENTLY remove the Velcro band from your leg and tape the tube in place on the thigh with NON-ADHESIVE tape (that won’t stick to body hair) while showering. Gently clean the uretheral area and the first 4-5 inches of tubing with soap and water to prevent infection. You may want to buy some antibacterial wipes for this purpose. The doctor may tell you to clean the urethral area and tube 2-3 times per day and it will be easier with antibacterial wipes. When you are ready to put the Velcro band back on, put the band on the opposite thigh so that you are rotating thighs each day. This will alternate any pressure that the tube is exerting on the inside of the urethra.
Your doctor will remove the urinary tube when you go to have the stent removed. The removal of this urinary tube is not painful, but may be a bit uncomfortable. Once the tube is removed, your doctor may require you to urinate (pee) before you leave his office. Drink some fluids while waiting. If you find you just can’t urinate, go for a walk. This will relax you and will help you urinate. IT IS VERY IMPORTANT THAT YOU ARE HONEST ABOUT BEING ABLE TO URINATE. There can be serious consequences if you don’t urinate within 8 hours of having the tube removed.
Terminology:
anesthesia: partial or complete loss of sensation with or without loss of consciousness.
anesthesiologist: medical doctor who specializes in administering anesthesia.
cystoscope: instrument used for the interior examination of the bladder and ureters.
cystoscopy: internal examination of the bladder.
indwelling catheter– tube inserted through urethra into bladder for the purpose of withdrawing urine; often referred to as a Foley Catheter.
Intravenous (IV): tube inserted into superficial vein for the purpose of administering fluids, blood or medications.
patient advocate: a person who acts to insure that a patient is served adequately by the health care system.
renal calculi: kidney stones
ureter: tube that carries urine from kidney to bladder; tiny in diameter.
urethra: tube that carries urine from bladder to outside of body.
urologist: medical doctor who specializes in the genito-urinary tract
stent: device used to keep a tube open
Anecdote:
My husband had a kidney stone that he was unable to pass. He ended up needing kidney stone surgery. As I was myself recovering from having had shoulder surgery 10 days before his procedure, I needed to ask a friend to drive my husband and I to the hospital as I still wasn’t allowed to drive. We had to be at the hospital by 6 am so as you might imagine, this was a GOOD friend! My husband was discharged once he woke up from the surgery and his vital signs were stable. Unfortunately, he was sent home with an indwelling urinary catheter. We had not been prepared for that scenario and my husband was quite upset. Nevertheless, we somehow managed at home. He was terribly uncomfortable, but I think it was from the stent rather than from the catheter. His urine turned from bloody to clear in a day or two and that was good. When we returned to the urologist’s office a few days later to have the catheter and the stent removed, my husband was quite anxious. Having the catheter removed was no big deal, but having the stent removed was no picnic. The stent was removed through a cystoscope. There was no sedation given and to this very day, I could kick myself for not asking the doctor to prescribe something for my husband to have taken that morning to take the edge off the anxiety… and discomfort. In fact, I told the doctor that after inserting the stent under anesthesia, it seemed almost barbaric to remove it without any medication. DO NOT LET THIS HAPPEN TO YOUR LOVED ONE. DEMAND SOME SEDATION before the removal of the stent. Discuss this in advance of the surgical procedure. If the doctor refuses your request, you may want to go to another doctor. You have a voice…use it!
After the urologist finished the procedure, we were told that we needed to hang round the office until my husband urinated. He kept drinking and drinking but was unable to go to the bathroom. After about 90 minutes, I told the nurse that I was taking my husband outside for a walk. She wasn’t happy about that but I promised her that we would return. We walked around the block and this relaxed him. We actually had to go into a fast food restaurant so he could use the bathroom. Hooray! We went back to the doctor’s office and reported that he had gone to the bathroom. You have a voice…use it!