How does the urinary system work?
The urinary system consists of the kidneys, the bladder and ureters. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys down through the ureters to the bladder.
The ureters tunnel through the wall of the bladder at an angle to form a flap that acts as a valve. There is also a ring of muscle (sphincter) at the junction of the bladder and the urethra that stops urine leaking out in between pees. When peeing, the muscles of the bladder wall squeeze the urine out of the bladder, at the same time as the muscles in the sphincter need to relax to let the urine flow down the urethra.
The valves between the ureters and bladder prevent urine flowing backwards into the ureters; so that all the urine in the bladder is passed in one go, as the urine cannot travel anywhere else.
As the urine leaves the bladder at a high pressure, the valves stop this high pressure being passed on to the kidneys.
What happens before the Operation?
You will receive information about how to prepare your child for the operation in your admission letter. On the day of the operation, your child should not have anything to eat or drink before the operation, for the amount of time specified in your admission letter. It is important to follow these instructions, otherwise your child’s operation may need to be delayed or even cancelled.
Your child’s surgeon may visit you to explain about the operation in more detail, discuss any worries you might have and ask you to give permission for the operation, by signing a consent form – if this was not done during your out-patient consultation.
An anaesthetist will visit you to explain about the anaesthetic and pain relief after the operation. If your child has any medical problems, such as allergies, please tell the doctors. Please also bring in any medicines your child is currently taking.
Most children do not require any `pre-medication’ – unless they are particularly anxious or distressed. The anaesthetic is administered as gas – via a face mask – or by injection. If your child chooses to have an injection, `magic cream’ (Emla® or Ametop®, topical local anaesthetic cream) will be applied 45 minutes – 1 hour prior to surgery.
You may accompany your child to the anaesthetic room and stay with him until he is asleep.
What does the operation involve?
The operation is carried out under general anaesthetic and lasts for between 1½ and 2½ hours. The blockage can either be removed using keyhole surgery (laparoscopy) or traditional open surgery. Your surgeon will discuss with you which method is most appropriate for your child.
In keyhole surgery, the surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. In traditional open surgery, the surgeon will make an incision in his or her side over the kidneys. The incision will be closed using surgical glue. Whichever method is used, the surgeon will locate the blockage in the ureter, remove the affected section and join the cut ends of ureter again.
Are there any risks?
There is a chance that the keyhole surgery will not be possible for your child. Sometimes the surgeon will not be able to carry out an operation using the keyhole method for technical reasons, or because of unexpected findings. If this is the case, the surgeon will carry out the operation using a larger incision. All surgery carries a small risk of bleeding during or after the operation. There is a risk that bleeding could occur when the surgeon removes the blocked section of ureter, but usually there is only a small amount of bleeding, which does not cause any problems.
There is a risk that urine could leak from the join in the ureter. Placing a tube (‘blue stent’) in the ureter to drain urine can help prevent this from happening. There is a small chance that the join may narrow so the flow of urine becomes blocked again, which may mean your child would need to have a second operation.
There is a risk of infection associated with all types of surgery, but your child will usually continue to take the antibiotics previously prescribed to prevent any infection developing.
Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to prevent and deal with any complications.
What happens after the Operation?
Your child will recover from the anaesthetic and operation on the ward and will be able to eat and drink soon afterwards, if he or she feels like it.
When he or she comes back from the operating theatre, there may be a thin, plastic tube (‘blue stent’) draining urine from your child’s kidney to give the ureter time to heal; this is usually blocked off one or two days (48 hours) after the operation, after which you and your child will be able to go home. The blue stent will remain for 7 days and your child will return after the 7 days on the ward to have the blue stent remove by our urology CNS. Some children return from theatre without any blues stent or may come back with international stents that will remain urethral are healed and will be removed after few month under general anaesthetists.
When you get home:
It is quite normal for your child to feel uncomfortable for a day or two after the operation. Usually paracetamol will be enough to relieve any pain, if you give it every four to six hours for the next day or so. If your child needs stronger medicine, we will give you some before you go home. If when you get home you feel that your child needs more powerful pain relief medicines, you should call your GP. In the days after the operation, you should encourage your child to drink plenty of fluids to flush out the kidneys.
Your child should not have a bath or shower for two days after the operation. After this, it is fine for your child to have a shower, but try to avoid long baths as this may cause the scab to soften and fall off too early.
You should call the ward, urology CSN or your consultant if:
What happens next?
You will need to come back to the ward a week after your child’s operation so that the ‘blue stent’ can be removed. This can be a bit uncomfortable, so make sure that your child has the maximum dose of pain relief possible beforehand.
The ward staff will give you details of this appointment before you leave the ward. Your child can go back to school when he or she is feeling well again, but should avoid rough and tumble play and contact sports until after the outpatient appointment. The doctor will see you and your child for a check-up about three months after the operation. We will send details of this appointment to you by post to your home address.
For further information please contact
We hope that you find this information helpful. If you have any questions or problems either before or after the surgery, please do not hesitate to contact, Clinical Nurse Specialist, on 020 7580 4400, 10838 (09:00 – 17:00 Monday to Friday) or email at: [email protected]
For Out of hours: Contact our Paediatric Site Practitioner via the switchboard on: 02075804400 ex 10843
Disclaimer Whilst this leaflet aims to provide you with useful information, it must be noted that it should only act as a guidance. Should you have any further concerns about this procedure, it is advisable that you discuss them with your Consultant.
