Open Nephrolithotomy

WHAT YOU SHOULD KNOW:

Open nephrolithotomy is surgery to open your kidney to remove kidney stones.

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:

  • You may get an infection or bleed more than expected. You may also feel pain and weakness in your abdominal muscles. Your stomach, intestines, blood vessels, or nerves may be injured during the surgery. You could have trouble breathing. Even after surgery, kidney stones may form again. You may get a blood clot in your leg or arm. This may be life-threatening.

  • Without treatment, kidney stones can stop urine from properly draining from your kidney. This can cause an infection, kidney damage, or kidney failure. This can be life-threatening.

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.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • An enema may be needed before your surgery. This is liquid put into your rectum to help empty your bowel.

  • General anesthesia will keep you asleep and free from pain during surgery. You may get anesthesia through your IV. You may breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • A Foley catheter is a tube put into your bladder to drain 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. 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.

  • An endotracheal (ET) tube connected to a breathing machine may be put into your mouth. This goes down the windpipe to keep your airway open and help you breathe during your surgery.

During your surgery:

Your caregiver may inject dye and use an ultrasound to see parts of the kidney. An incision will be made on your side. Your caregiver will make an incision in your kidney and remove the stones. Your caregiver may also remove a small part of the kidney to help the urine drain better. He may remove the whole kidney if it is badly damaged by the stones. X-rays of the kidney will be taken to check if all stones have been removed. Thin tubes will be put near the kidney to drain fluid from your incisions. The incisions will be closed with stitches or surgical tape and covered with bandages.

After your surgery:

You will be taken to a room to rest until you are fully awake. Caregivers will monitor you closely for any problems. Do not get out of bed until your caregiver says it is okay. When your caregiver sees that you are okay, you will be taken 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.

  • 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 will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath. Then let the air out and cough. Repeat these steps 10 times every hour.

  • You will be able to eat and drink gradually after surgery. You will begin with ice chips or clear liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then eat soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Intake and output of liquids may need to be tracked. Your caregivers may need to track the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers may need to strain your urine to check for stones. Do not flush your urine down the toilet unless caregivers say it is okay.

  • Medicines:

    • Antibiotics help treat or prevent an infection.

    • Antinausea medicine calms your stomach and prevents vomiting.

    • Pain medicine will decrease your pain. Do not wait until the pain is severe to ask for your medicine. 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.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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