Robotic Pyeloplasty Postoperative Instructions

Dressings

  • Your child has 3 or 4 small (8 mm) wounds. These have been sewn with small absorbable suture. There is also surgical glue and Steri-Strips underneath the band-aids. Please just let all these fall off on its own.
  • The belly button tends to be puffy and swollen for a few weeks. By 3 months the belly button should look back to normal.
  • Sometimes you can see the end of the suture sticking out from the ends of the incision after the bandages fall off. If that is the case, you can cut these ends or just let them fall off on their own.

Shower, bathing, and swimming

  • It is ok for your child to shower 24 hrs after surgery.
  • We recommend to no bathing or swimming for 1 week

Pain medicines

Acetaminophen (Tylenol) and Ibuprofen (Motrin) are usually all is needed for pain.

Each of these medicines can be given every 6 hrs. You can give both at the same time every 6 hrs or give one of each every 3 hrs:

  • Tylenol at 9 am
  • Ibuprofen at 12 pm
  • Tylenol at 3 pm
  • Ibuprofen at 6 pm…

Please give these medicines for 24 hrs on a schedule. After 24 hrs you can give the medicines on as- needed basis.

Please call if the pain is not been controlled by these medicines to prescribe something stronger.

Ureteral Stent

A ureteral stent was placed during surgery to allow things to heal straight and prevent leaking of urine around the sutures.

The ureteral stent is removed 4 weeks after surgery during brief general anesthesia (usually with just a breathing mask and no IV). To remove the stent, a small scope is introduced through your child’s urethra (the opening where the urine comes out) and the stent is then grasped from inside the bladder and pulled out. The procedure normally takes under 1 minute.

Most children do well with the stent with no discomfort. However, some do have stent-related discomfort manifested as pain with urination irradiated to the side of the surgery. This type of pain responds well to a medicine called Oxybutynin. Please call if you think your child has stent-related pain to prescribe this medicine.

Antibiotics

We recommend a daily preventative antibiotic while the ureteral stent is in place for girls and uncircumcised boys. The benefit of the antibiotic for circumcised boys is minimal and that is why we don’t recommend it for them.

Bladder and bowel function

Because the stent allows urine to flow freely from the bladder up into the kidney, it is important for your child to void regularly (every 3 hrs during the day) and to avoid holding his urine. For the first 2 nights, we recommend that your child voids once in the middle of the night to prevent the pressure in the bladder from putting pressure on the kidney repair.

Avoiding constipation is also important to prevent urinary tract infections and problems with healing. Feel free to use over the counter glycerin suppositories once a day and/or Miralax (1/2 to 1 capful in one glass of water) once a day.

Activities and sports

No coach directed activities for 3 weeks.

Your child can move around and play as he or she wishes as long as someone is not pushing him or her to do things (a coach)

Follow- up

4 weeks after surgery to remove the ureteral stent in the operating room

3 months after surgery to repeat renal ultrasound.

  • If the ultrasound shows some improvement in the urinary tract dilation we consider the surgery to have been successful.
  • Also if your child was having recurrent episodes of pain and they stop, we consider the surgery successful.
  • If the dilation is the same and your child is doing well, sometimes we just keep an eye on things for a few months.
  • Only when the dilation is worse we would repeat the nuclear medicine scan.

Problems

Please call for fevers, vomiting, severe abdominal pain, bulging from the surgical incisions, or anything that is concerning to you.