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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• 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 is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• 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: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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 okay. When caregivers see that you are okay, 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: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.
  
  
  • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• 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: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• 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.