Open Nephrolithotomy

WHAT YOU SHOULD KNOW:

• Open nephrolithotomy (nef-ro-li-THOT-o-me) is surgery to completely remove kidney stones. Kidney stones are rock-like pieces or crystals formed from the urine. These may cause pain, infection, bleeding, and damage to the kidneys. Kidney stones usually form in the kidneys but may also be found in other parts of the urinary tract. The kidneys are two bean-shaped organs located in the back of the abdomen (stomach), at both sides of the spine. They remove unwanted chemicals and waste from the blood in the form of urine. The urine flows from both kidneys through tubes called ureters. The bladder is a hollow, round organ that holds urine. Urine leaves the bladder and goes out of the body through another tube called the urethra.
  
  
• Open nephrolithotomy may be done to take out large stones or when other procedures have not worked. This may also be done for people who are obese (very overweight) or those with other health problems. During this surgery, an incision (cut) is made in the flank (side of the abdomen) area. This is done so the affected kidney and many structures lying close to it can be fully seen. The kidney is then opened and the stones are removed. With open nephrolithotomy, symptoms may be treated and more serious health problems prevented.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Problems, such as bleeding that cannot be controlled, may happen during your surgery. You may also feel pain and weakness in your abdominal muscles. Your stomach, intestines, blood vessels, or nerves may also get injured during the surgery. You could also have trouble breathing or get an infection. Even after surgery, kidney stones may form again and cause problems.
  
  
• If left untreated, you may get a kidney obstruction or infection and not be able to pass urine. These may cause further damage to your urinary tract. If waste products are not removed, you may get sepsis (blood infection) or your kidneys may stop working. This may lead to more serious and often life-threatening problems, such as heart, liver, or brain damage. Ask your caregiver if you are worried or have questions about your condition, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During your surgery:

• Your abdomen, flank, and genital areas are cleaned with soap and water. Sheets are put over you to keep the surgery area clean.
  
  
• An incision is made on the flank area of the affected kidney. Your caregiver will use special tools to pull the flank muscles to each side. He may use an ultrasound and inject dye to see parts of the kidney, and any stones present. He then opens your kidney and removes the stones inside it. Your caregiver may also remove a small part of the kidney to help the urine drain out better. He may take your whole kidney if it is badly damaged by the stones. X-ray pictures of the kidney are taken to check if all stones have been removed. Thin rubber tubes are put near the kidney to drain blood from your incisions. Your incisions are closed with stitches (threads) or surgical tape and covered with bandages.

After your surgery: You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound or drains. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. You should drink about 3 to 4 liters of liquid each day (around 13 to 17 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. Your caregivers may also need to know how much you are urinating. Ask them if they need to measure or collect your urine before you dispose of it.
  
  
• Medicines: Your caregiver may give you the following medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  
• Tests and monitoring: Caregivers will take your vital signs frequently for several hours. The pulses on your legs and feet will also be checked often. This may help the caregiver learn if you have any problems with blood flow after your surgery.
  
  
  • Blood and urine tests: Samples of your blood and urine are sent to a lab for tests. These tests check how well your kidneys are working.
    
    
  • Other special tests: Different tests, such as angiography, may be done to look for problems with blood flow in your urinary tract. With angiography, a catheter (long, thin, bendable tube) is placed in a blood vessel in your groin. The groin is the area where your abdomen meets your upper leg. A dye is put into the catheter. Pictures are taken using an x-ray or a computed tomography (CT) scan after the dye goes to your kidneys.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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