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Types of Surgery

Conditions We Treat


 

 What You Need to Know

 

 What you need to know if you have a stent

The Good:  Stents are good because they help your kidney drain better.  If your kidney does not drain for a prolonged period of time it can stop working.
 
The Bad: Most stents are uncomfortable at first.  Although your body can get used to this foreign object, the bladder spasms to try and get them out.  Bladder pain, urinary frequency, and burning, similar symptoms to an infection are all normal with stents.  You can certainly always get checked for infection to make sure there aren’t two things going on, but 95% of the time or more, urinary frequency and burning are just normal reactions to a stent.  A small amount of blood in the urine (that can turn the urine orange or light red) is also normal.  The stent irritates the bladder just enough to allow the release of a few red blood cells. 
The Ugly:  A stent is a plastic tube with a curl at the top and at the bottom. The curls keep the stent from moving up from the bladder or down from the kidney.   Stents are about 12 inches long.  Occasionally your doctor will leave a string coming out of your urethra that is attached to the stent.  Pulling the string can remove the stent. More often, however, your doctor will need to slide a scope into the bladder to grasp the stent for removal.  This short procedure can be done with local anesthesia in the clinic.  
The Important: If a stent is not removed within 6 months it can actually become calcified and block the kidney from draining.  This can make removal difficult as well.  If the cause of your obstructed ureter is not just temporary, you will need a new stent to replace the old one about every 6 months.  If you do not replace or remove your stent, it will calcify and become nearly impossible to remove and will block the kidney, decreasing function. If you need your sent removed or replaced please call Jolene to schedule an appointment at 720-848-1388.
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 What you need to know if you have a catheter

 1.  Draining the catheter is easy!  By now you probably know to open the valve at the bottom of the collection bag when it fills to release urine into the toilet or sink.  Changing from the night bag to the leg bag is easy as well.  One simply pulls away the clear plastic tubing from the catheter end (while holding on to the catheter so it doesn’t pull)  (sometimes it takes a little jiggling and patience).  This pulls the old tubing out and new tubing is ready to be inserted.  Rinse bag with diluted bleach (1 part bleach for 10 parts water and store in a dry place).
 
2.  Protect your catheter.  You need it.  Note the picture above.  The balloon at the top stays inside keeps it from falling out in the drawing above. Try to avoid situations where it can get caught on the gearshift, the bedpost, or the corner of the door.  If the balloon pulls out while inflated this can spell bad news in lots of ways.
 
3. We like to see the catheter bag below the level of your bladder.  We do not want bacteria from the collection bag backwashing back into the bladder.  Make sure there are no kinks in the tubing.  For your comfort, antibiotic ointment or Vaseline at the point where the catheter exits the body in male patients oftentimes helps the discomfort from small movements of the catheter.
 
4.  Realize no catheter will collect 100% of the urine.  Urine will always, and I mean always, leak around the catheter and get your underwear wet. Expect to have urinary leakage while you have a catheter in place.  Most people wear absorptive protection (yes guys, even maxipads) in their undergarments while they have a catheter in.
 
5. Blood in the urine is absolutely normal with a catheter in place.  Expect to see blood intermittently in your urine when you have a catheter.  Remember the internal balloon.  This balloon rubs on the inside of the bladder softly and causes non-dangerous expected bleeding.  As long as the catheter is draining there is no cause for alarm.  If a clot catheter back-up you need to come to the clinic or the ER for irrigation.  The amount of blood in the urine with a catheter looks to be more than it is.  Blood in the urine is like food coloring. So even a couple of drops of blood can make the entire thing look very red. Your body is constantly making new blood which is almost always enough to make up for the small amount that is lost.  However if you feel that your heart is racing or that you are busy and have been having a copious amount blood in your urine with clots for several weeks you may be anemic.  Discuss these symptoms with your provider or seek medical attention if your urine all-of-a-sudden looks like red wine or you don’t feel right.  This occurs in less than 1% of patients with catheters.
 
6. Infections can be a problem with catheters.  If you have had a catheter for more than a week you might need antibiotics with your catheter removal. Please do not hesitate to discuss antibiotics with your provider when your catheter is removed.  Signs of infection include persistent burning with urination, urinary frequency, and fever.
 
7.  Bladder spasms are extremely common with catheters.  The only thing the bladder knows how to do when it is irritated is contract. The bladder is trying to contract to push the catheter out.  A bladder spasm is a deep pressure or pain that can be quite severe above the pubic bone. They spasms generally go away once the catheter is removed in most situations.  There is a medication that can remove butter spasms. Most of these medications cause dry mouth and cannot be taken if you have glaucoma.  
 
8. The clinic number is 720-848-0170.  Call and leave a message for the nurse handling phone calls in clinic or email your provider through MyHealthConnection if you need medication for infection or bladder spasms. Call the help desk for problems with MyHealthConnection (720-848-0000).  The doctor on call for Urology can be reached by calling 720-848-0000 and asking to talk to the physician on call for Urology.
 
9. Realize that catheters will not change long term avoiding patterns. The catheter doesn't generally damage any internal structures in the long run.  The catheter is merely a temporary drain.  You will get back to normal – assuming surgery didn’t change things.  You can’t control the flow of urine through the catheter, so we generally don’t recommend trying.  However, if your catheter was put in because your bladder or prostate was taken out, you might want to practice tightening your sphincter muscle with it in place.  This strengthens it faster as an isometric exercise.  Kegel exercises, as a general room are quick contractions of the urinary sphincter 10 times each hour
 
10. There is a small chance you won’t be able to eliminate urine if the bladder is dysfunctional or if your outlet is still swollen when the catheter is removed.  If you are at home, you may try sitting in a warm tub and see if the urine will release.  Stop drinking fluids any fluids if you feel that you cannot empty your bladder and head back to clinic if it is between 8-430 (call first! 720-848-0170) or to your nearest emergency room if you are in severe pain or it is after hours.
 
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 What you need to know about surgery

GENERAL CONCEPTS:
You are scheduled for surgery (or a procedure) at the University Hospital in the near future.  Although these things become fairly routine, we never take any surgery for granted.
Any surgery can have complications.  These can range from expected soreness after a procedure to something more major with your heart or lungs – thankfully these major things happen less than 1% of the time.  Any laparoscopic or robotic procedure occasionally may be converted to an open procedure, and, occasionally when we set out to take part of an organ removal of the entire organ is required.  Rarely, a routine procedure can result in several surgeries and a prolonged hospital stay.  Our surgeons are experienced, well-trained individual and care about every patient and every procedure.  They will do every possible thing to get you through this procedure and back to a happy, productive life.  If you do not feel fully informed or if you have any questions at all, call our nursing line at 720-848-0170 or email your provider through MyHealthConnection.  Also, remember, your surgeon will be touching base with you again about an hour before your surgery when you come to the hospital.  Feel free to come with other questions you have thought of.
SCHEDULING:
The Operating Room schedulers should call you a few days before surgery.  They will tell you exactly what time to come to the hospital.  In general, patients are instructed to not eat any more solid food after midnight on the night before their procedure.  You may drink clear liquids you can see through until 2 hours before you are supposed to be at the hospital.  Occasionally times will shift as the date gets closer and they are moving patients in exactly the right slots on the grid.
BLOOD THINNERS:
In general you should be off blood thinners, aspirin, anti-inflamatory over-the-counter agents (Aleve, Motrin, AlkaSeltzer etc.) a week prior to your procedure.  Your primary care provider should ok your coming off major blood thinners and aspirin.
AND FINALLY:
Relax, take a deep breath, and realize every minute you are getting closer to  having your surgery over with!
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 What you need to know about wounds

What’s normal
-         A little clear drainage (a few drops a few times daily)
-         A little redness around the edges
-         A little bloody drainage (a few drops a few times daily)
-         A little whitish drainage
-         Redness or a little whitish drainage around tubes that exit the skin
-         A little redness around staples
-         Low grade fever (100 or lower) that goes away with time
 
What’s not unusual
-         A little opening where the skin came apart (it will just heal over)
 
When you need to call (720-848-0170)
-         If your incision is red and warm to the touch, this can be an infection
-         If there is more than a half cup of a drainage from the wound this could mean there are issues with the deep sutures
-         If there is more than a thimbleful of thick, white, milky drainage coming from wound this can be a sign of infection
-         If any tubes come out they may need to be put back in
-         Fever above 100 degrees Fahrenheit
-         When fluid stops draining from tubes that were previously draining
-         If you just don’t feel right
 
When you need to call 911 or go to Emergency Deptarment
-         When you have chest pain
-         When you are short of breath so that you can’t finish a sentence
-         When you have leg swelling that is new and just on one side
-         When you are feeling light-headed or dizzy
-         When you can’t keep any food or drink down for a 24 hour period
-         When your heart is racing for more than just a few minutes
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