Thyer Urology

Pre operation

Ten days prior to the procedure you should:

• Have your blood and urine test
• Notify Mr Thyer’s rooms if you are taking any blood thinning medication

The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 3 hours. Mr Thyer will make a series of 5 small incisions in the abdomen to allow the passage of the robotic instruments. The ureter will be dissected free from its surrounding structures and the section containing tumour removed. The ureter will be re-joined using sutures or the ureter may be reimplanted directly into the top of the bladder. The ureter and tumour will sent to a pathologist for microscopic examination (you may incur a pathologist fee). A catheter will be placed in the bladder to remain for 2 weeks. A ureteric stent will remain in the ureter for a period of 6 weeks to prevent leakage of urine through the suture line. After the operation a drain will be left in the abdomen. Most people are in hospital 2 nights then discharged home after Mr Thyer’s review.

Risks

• Bleeding. Bleeding from the operation site is very rare but if occurs may necessitate a return to theatre.
• Infection. Wound infection is rare but may require a course of oral antibiotics to correct. Bladder infection is quite common as a catheter remains in the bladder for 2 weeks.
• Conversion to open ureterectomy. Occasionally a ureter is more difficult to dissect free than anticipated using the robotic or laparoscopic technique and conversion to open approach is required.
• Injury to surrounding structures. The bowel, gynaecologic organs and large blood vessels are close to the ureter and may require repair if injured during the dissection.
• Urine leak. Occasionally the urine can leak between the sutures placed to close the defect in the ureter. A drain or bladder catheter may be required until the leak stops.
• Ureteric stricture. The joined section of ureter can rarely narrow down over time necessitating dilatation or repeat operation.
• Conversion to radical nephro-ureterectomy. If there is concern during the operation that the tumour will not be completely removed or if the ureter cannot be sutured back together then conversion to remove the whole kidney and ureter is required.
• Recurrence of cancer. 50% of people undergoing this operation go on to develop cancer recurrence in the bladder. Mr Thyer will check your bladder every 6 months to ensure this is detected quickly and treated.
• There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.

Follow up

You will require a CT cystogram at 2 weeks to ensure there is no leak of urine from the bladder or ureter. If the CT is satisfactory then the catheter can be removed from the bladder usually the same day. Mr Thyer’s rooms will contact you to arrange follow up to check your progress, wounds and pathology 3 weeks following the operation. You should take laxatives, wear compression stockings, drink plenty of water and avoid heavy lifting for 3 weeks following the procedure. You should not drive a motor vehicle until seen by Mr Thyer at the follow up appointment. Flexible cystoscopy to remove the ureteric stent will be required at 6 weeks following the operation and then every 6 months to ensure there is no cancer recurrence in the bladder.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

• Have a fever over 38 Degrees
• Feel the catheter is not draining urine
• Have not received a follow up appointment
• You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000
• You can attend the emergency department at the hospital at which you had your procedure. (Hollywood Private Emergency Department charge a fee for attendance).