Robotic Pyeloplasty Surgery – IntroductionLaparoscopic pyeloplasty surgery. That is not something you ever thought you would need. Neither did I, but I did and had nowhere to go to find out what to expect. I could not find anything online about what to expect before and after a laparoscopic robotic pyeloplasty surgery. So, I am going to fill in the gaps for you as it might help calm some of your anxieties.
Pyeloplasty DefinitionWhat is pyeloplasty? First off, I am not going to get into the technical details other than the following. You have an obstruction that is preventing proper drainage of urine from the kidney. That is a big problem. If this obstruction continues, the affected kidney will start to die. The urine builds up in your healthy kidney and kills off the healthy nephron cells. In short, you cannot drain urine from your kidney. If you currently have any type of hydronephrosis, swelling of the kidney, this is an urgent matter. Make sure to take your health into your hands and check what your GFR (glomerular filtration rate) number is. Do not listen to any doctor that tells you it is no big deal and just to drink 2 liters of water a day. If your kidney drainage is blocked, you are a walking time bomb. All you need is a simple blood test to tell you. Unfortunately, sometimes this number can be missed by your primary care physician because it is usually at the end of a typical blood panel. Check your GFR (glomerular filtration rate); make sure it is over 60, and you are not in chronic kidney disease territory. CKD is silent, and while you think everything is fine, you might not be aware of the catastrophic deterioration of kidney function. Once you start losing kidney tissue, it is gone forever. You do not want CKD, because this means eventual dialysis or a kidney transplant. So, treat any hydronephrosis of your kidney as an urgent matter and take immediate action. The question is, what can you do if the hydronephrosis is due to an obstruction?
Ureteropelvic Junction UPJ ObstructionThe obstruction could be from a kidney stone, or you could have been born with it. Or this UPJ obstruction, aka ureteropelvic junction UPJ, could be congenital, something you are born with from birth. The bottom line is that once you have a UPJ obstruction, you are now facing an anatomical blockage. This means that you cannot correct it by eating less animal protein or a more alkaline diet. There is no dietary intervention that will save you from the catastrophic effects of an obstruction.
Signs of ObstructionSome signs of obstruction are:
- flank pain
- or sudden intense flank pain
Pyeloplasty is a True Medical MiracleLaparoscopic pyeloplasty surgery can resolve this ureteropelvic junction obstruction with minimally invasive surgery. As hard as this might be to believe, the technology exists today where your surgeon can make an incision in your belly button, the size of the tip of your thumb. They then insert all the instruments necessary for the pyeloplasty through that tiny incision. Don’t get me wrong; this incision is going to hurt for many weeks. And, the pain and tenderness of this incision will leave you with limited mobility for several months. But, I will get to that a bit later when I discuss what you can expect the day after robotic surgery, and the week after surgery and beyond. The surgeon will then cut the healthy ends of your ureter, the width of a kite string, reattach them, place a tube called a ureteral stent to promote healing, close you up, and now is the hard part. You have to recover. You know nothing till you wake up from the anesthesia cocktail. But when you do, and the narcotic effects wear off, I am sorry to say that you will feel it.
Is Laparoscopic Robotic Pyeloplasty Major Surgery?Here is the answer to your question if open pyeloplasty is a major surgery or not: Yes. Pyeloplasty is not a little procedure. No matter how small the incision is, pyeloplasty is major surgery. So be prepared. The main benefits of robotic-assisted laparoscopic pyeloplasty are:
- Greater detail for the surgeon to see the via the robotic lens
- More stability using the instruments held by the robot on your precious organs and guided by the surgeon.
- A small incision
- Shorter hospital stay (that does not mean you will feel any better, just that you can leave the hospital faster for your benefit, so you don’t end up with an infection that is worse than you are already dealing with.)
Pyeloplasty Procedure Video
A Random Blood TestRandom blood test results showed on January 10th, 2019, that my kidneys were not functioning correctly. My GFR was between 47 and 51, meaning I have chronic kidney disease, and I had no clue because I was feeling fine. I had a blood test because of the flu and had no symptoms to tell me that I was losing my left kidney day by day. A CT scan on January 10th showed severe hydronephrosis of the left kidney and extensive damage to tissue. At the time, I did not understand that this was a mechanical obstruction and that only surgery could help. I still held out hope for some type of dietary intervention. It is in cases like these where modern medicine is a real lifesaver.
Nuclear Medicine ScanOn March 1st, I did a nuclear medicine scan. That was a walk in the park compared to a closed MRI. In any case, the results showed that I only had 20 percent of function remaining in the left kidney. I was devastated. My left kidney was dying, and if I had not taken that blood test, I would never have known because I was not having any pain or discomfort. Also, I was in immediate danger of infection or sepsis, which can result from the lack of drainage in the blocked kidney. I went to five kidney specialists, two surgeons, and three nephrologists. There was a unanimous consent that for 20 percent, it is worthwhile for surgical intervention. First, I went to a urologist at NYU Langone in New York City who said he would do a cystoscopy to try and clear the obstruction and that there was a 50 percent chance it would be successful. For a second opinion, I went to another urologist who said that the cystoscopy would not work in my case. The UPJ obstruction, in my case, was caused by crossing blood vessels, a congenital condition. A Crossing blood vessel means that I was born with one blood vessel that was pressing down so hard on the ureter that urine could no longer drain. Dr. Michael Stifelman, chairman of Urology at Hackensack University Medical Center, said that pyeloplasty surgery has a 98 percent success rate. And he will use the latest and greatest robot called the Da Vinci. The robot magnifies all of the elements in the body and allows the surgeon to be exact. I had to choose between doing nothing or doing the surgery with pain now, but hopefully saving my left kidney, reversing the chronic kidney disease, and avoiding dialysis or transplant in the long term. If the surgery works, the pain is worth it, and that is what I chose.
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One Day Before Pyeloplasty SurgeryThey scheduled surgery for April 1st, 2019. Not the best Day I could imagine, but the alternative was to wait another month. Unbeknownst to everyone healthy right now, there are so many people waiting for surgery to help them. As an aside, I realized how amazing it is that one obstruction of just one tube leading to the urinary tract in your body can create incredible havoc — requiring open surgery. If you get up in the morning and can go to the bathroom regularly, walk around, get up, sit down, even sneeze, breathe, without physical pain, that is something to celebrate. In any case, the previous day I was instructed to drink a bottle of magnesium citrate and do an enema in the evening. I put the magnesium citrate in apple juice. The big mistake I made was not to chase the concoction with water. Because by the end of the day, my teeth were killing me. And only this magnesium citrate was allowed, together with water or other clear liquids. It is a vile drink, so do your best to drink enough water afterward, so the solution does not cause your teeth to get too sensitive. It took me hours to finish it off. You cannot have any other solid food, approximately 24 hours before the surgery.
Day of SurgeryStaff were all kind and accommodating at Hackensack. But that does not take off the edge of fear and anxiety when you have to disrobe and know that soon they will be making an incision in your body. It gets emotional in the waiting area, especially when the physician assistant asks in front of your wife if you have a living will or not. Because so many speak about overnight hospital surgery as a procedure, you do not expect a question implying you could die.
In the Operating RoomThe attendants wheel you in on a table in your gown. Lift you and move you to the operating table. I could see my reflection in one of the enormous lights and wondered how fast life passes by. I imagine it is human nature. We never expect to be in such a situation. I saw myself with the head covering on and said a prayer. The anesthesiologist said something, and the next thing I knew, I was singing five hours later. I remembered nothing in between, thank G-d. But the hours after surgery were nothing less than horrific as the pain medication wore off.
After Pyeloplasty Surgery
Laparoscopic Pyeloplasty Recovery TimeI spent the night in a hospital room. In a ward where there were many other kidney patients. Some who had surgery for cancer and some who were going through a transplant. If you are not in a hospital today or any day, that is another excellent reason to celebrate, no matter how much of a jerk your boss is. The moaning and groaning of many patients were disturbing, besides my pain. Oxycontin, a narcotic, reduced the pain, but it quickly wore off. By midnight, 12 hours after the surgery, I was in intense pain. I am not telling you this for you to not have the surgery. Instead, you should know now what options you might have to reduce your pain. And, if you can start living a healthier life today, as well as monitor your blood test results, do it. You never want to go through this agony.
Catheter RemovalBesides the misery of the incision in your stomach, you wake up with a catheter. I think most men would agree that a catheter seems like the worst form of medieval torture. The nurse said that she would be taking it out about midnight, and it is not a big deal. Really. Not a big deal? I do not think so. If your doctor can put you back under, I’d do it. Whatever sedative gels they can use, go for it. The catheter removal was the most fearsome torture I can remember in my life. Just thinking about it as I am writing these words makes me wince. Unfortunately, technology today still requires a catheter to help your kidney drain fluid. The good news is once the catheter is out, you are now free of one of the worst moments a man can imagine.
Lack of AppetiteDon’t expect to be ready to enjoy a meal. I could not eat, and even though I felt like I wanted to urinate, I just felt the pressure and burning, but nothing came out. At 5 am another doctor said he would have to reinsert the catheter if I did not pass urine. Do you see how great it is that you can go without needing a catheter? I was so frightened by the catheter that I pushed myself harder to go. Finally, it was enough that the doctor stopped threatening to use a catheter. I could not sleep all night. In the middle of the night, I tried to walk to prevent blood clots. I could barely walk. And they gave me a tube to breathe into to prevent pneumonia. Pyeloplasty is not a procedure. Getting a mole off your face is a procedure, not a laparoscopic surgery. Filling a cavity or even putting a crown on a tooth is a procedure. Robotic pyeloplasty is a significant surgery, no matter how ‘minimally invasive’ advertisements say it is.
The Week After Pyeloplasty Surgery
Day After SurgeryApril 2nd, my father’s birthday. I was surprisingly released from the hospital at 11 am. Very sore and tender where the incision was. I decided not to take additional morphine or oxycontin because of their constipating effects. I already could not do anything. Driving home in an uber, every bump in the road hurt. And a sneeze or cough killed me with pain. At that point, I was still on Tylenol. And a liquid diet until the first bowel movement. General anesthesia puts your digestive system to sleep, and it takes time to wake up. Until that point, you can only have a liquid diet, clear broth, water, some juices. You are pretty limited.
Two Days After SurgeryApril 3rd – Urination still very difficult and painful. Still taking Tylenol. But no oxycontin. The IV solutions during the operation will leave you with swollen hands and feet. My left knee, where I have a torn medial meniscus, starts to stiffen up so much that I can no longer walk at all. I cannot sleep at night. Mainly because I cannot lie down due to the incision, so sleep sitting up and wake up every hour to void as they call it. I took a total of 3000 mg of Tylenol over the day.
Three Days after SurgeryApril 4th – I start to freak out because I see blood in the urine. That is one frightening sight. The doctor assured me this is normal and to only be concerned if I see a clot, have flank pain, or a fever. A small bowel movement allows me to graduate to soft food — still no real food, just some puree, and mashed items. You will never feel as good passing some gas as now because you will be getting rid of some of the gas which the surgeons use to expand your body and make way for the instruments and surgery.
Four Days LaterApril 5th – Finally, the blood in the urine stops. That was a great relief, but the pain and tenderness do not. Nevertheless, I am feeling a little bit better. Ankles and hands are still a bit swollen, and left knee still hurts, so I can only hobble around. If you are mobile today, put on your running shoes and celebrate!
5th dayFriday, April 6th – swelling in hands is gone. Urination still hurting. But the tenderness of incision getting a little better. Finally, I took off my t-shirt and saw all of the bloodstains on my stomach. We are only flesh and blood, flesh, and blood. Very sobering. Another bowel movement allowed me to eat more regular but bland food. Friday night, I got dressed and felt a bit philosophical. Voice was still sore from the tubes they put down your throat for breathing during the operation.
6th dayApril 7th – Trying to keep my weight up by eating more. From the day before surgery for another four days, I lost five pounds in total, mainly had some liquids. Surgery is not the way to lose weight. If you need to lose weight, try my guide to lose 20 pounds in 3 months. I spent the day reflecting on how different circumstances led to finding out that my kidney was near failure, and allowed to save it.
Sunday the 7th dayApril 8th – I still cannot lift anything that weighs than 10 pounds. Still waking up multiple times in the evening. But can lie down a bit more at night. So got my first sleep of a couple of hours. But, felt good enough to walk outside for 15 minutes. That was refreshing.
The Remainder of AprilFor the next month, walking was very uncomfortable. I thought the stent is only an inch, but in fact, walking with a 10 to 12-inch stent inside you from your kidney into the ureter to the bladder is not comfortable, so don’t get too happy. During this time, I did my best to keep my weight up and was optimistic that my left kidney was now safe. Your Kidneys are so powerful that even 20 percent can keep you alive just fine if your other one shuts down.
Stent Removal after Pyeloplasty and Upsetting newsOn May 2nd, 2019, I had the stent removed. Because of the catheter removal experience, I opted to be put under, in the twilight, as they call it. That was one of the best decisions I made. So, I recommend the same for anyone else who has significant discomfort from the catheter removal. On May 30th, I had additional tests, and while I was in the nuclear medicine test, I noticed that I could not see my left kidney at all. That was not a good sign. The nuclear medicine test at Hackensack confirmed that I only had 4 to 7 percent function remaining of my left kidney. My surgeon, Dr. Stifelman, showed me the scans from NYU, and looking at them, I could see that they looked the same as the ones from Hackensack.
Overreading – Always See the ImagesSo why did the radiologist in NYU say that I had 20 percent left when you could see nothing of the left kidney. The doctors call that overreading, where the radiologist over or under reads the results. Note to you, make sure you have your surgeon see as many of the images and scans that you have, and not just rely on the written report. To say I was despondent would be an understatement. I pretty much lost my left kidney from this UPJ. The good news, though, was that the surgery saved my life because, without it, I could have had internal bleeding, infection, or sepsis. You need two things with your kidneys, drainage, and filtration. My surgeon and urologist were both encouraging that you can still live a healthy life living with one kidney. They always mention that kidney donors do that all the time. And hats off to anyone who is a kidney donor, because you go through tremendous pain to make such a sacrifice.
Pyeloplasty ScarThe scars are the least of your worries. There will be one scar on your belly button, barely noticeable. The problem is not the scar, the main hurdle will be the pain and discomfort, even when taking a shower, coughing, or sneezing, until it fully heals. A good tip for your recovery is to keep massaging your stomach area. You will likely feel some knots or protrusions, they will eventually smooth out, and pressing them out will help. The second scar is below the waistline where they make an incision for a robotic pyeloplasty port placement to remove fluids during the operation. This scar too is barely visible, and maybe an inch long. Don’t worry about the scars. Find the best surgeon you can who uses the Da Vinci robot for your Pyeloplasty surgery.
Kidney Pain After Pyeloplasty OpI did not experience kidney pain after pyeloplasty. My pain was from the area of the incision, and the discomfort of the stent. But as far as kidney pain, I could not tell if I was feeling any pain. Of course, it could be because, in my case, I have very little left of my left kidney, most of it was lost because of the UPJ obstruction. And even while my left kidney was deteriorating, I did not have pain.
Six Months after SurgeryMy last test on October 6th, 2019, showed a GFR of 57, which is as much as you can expect with one kidney. The best news is that there is no hydronephrosis or stones visible in either organ. Now I can walk again, and even do:
- deadlifts, and
- squats, though I am working back into resistance training.
January 20th, 2020For the last three weeks, I feel the sword of Damocles hanging over my head, because my creatinine levels rose from 1.21 to 1.39. This increase meant that my doctors wanted another sonogram, and just got the results today that there is still no obstruction of either kidney. Now, the hope is that the increased creatinine levels are due to a lack of hydration. So, I will be redoing another blood test shortly towards the end of the day, as opposed to the beginning. Also, I recently started to incorporate the Yoga practice of Pranayama, deep breathing, specifically Khapalbhati and Anolom Vilom. We will see if they help to lower creatinine or stabilize the persistent atrophy of my left kidney.
February 10th, 2020I took a new renal panel blood test, and Thank G-d, my creatinine decreased from 1.39 to 1.27. Was the decrease in creatinine because I took the blood test at the end of the day when I made sure to have had at least 3 liters of water? Or was it because I have been drinking 3 liters of water for the last month? Or does the decrease reflect the benefits of pranayama, yogic breathing, specifically Khapalbhati and Anolom Vilom? For the last 30 days, I have been practicing Khapalbhati and Anolom Vilom every morning for one hour. Yes, I also never heard of pranayama, Khapalbhati or Anolom Vilom till recently. As fate would have it, I watched the Ramdev movie on Netflix. The movie itself is inspiring because Ramdev grew up in circumstances where you would never believe he would become a revered yoga teacher and guru in India and worldwide. In the movie, Ramdev and his friend Balkrishna heal many conditions through these two methods of breathing. They prescribe Khapalbhati as a kidney exercise, as well as a massage of other internal organs. And on several videos only available in Hindi, Baba Ramdev hears testimony from his followers who lowered their creatinine with Anolom Vilom. More than that, Ramdev says that an atrophic kidney (like mine) could begin to rejuvenate with the practice of Anolom Vilom. Even if you do not know Hindi, watch Ramdev demonstrate Khapalbhati and Anolom Vilom Pranayam (Yogic Breathing) in this video:
March 2020Between November 2019 and January 8th, 2020, I completely stopped weightlifting because of the high creatinine. I had already stopped eating meat way back on January 10th, 2019, when I first learned of the severe hydronephrosis of my left kidney. Nevertheless, the January 8th test results were the highest creatinine levels ever causing concern that either the pyeloplasty surgery had failed, or my right kidney was in trouble. Once I found out through a sonogram that there was no indication of hydronephrosis in either kidney, I decided to go back to the type of 3×5 workout that I like best, where I squat and deadlift on the same day, and do bench press and other assistance exercises on alternating days. For example:
- Monday Squat 3×5 and Deadlift 1×5
- Tuesday Bench Press 3×5 plus bench press assistance exercises like:
- incline bench press
- butterfly machine
- dumbbell shoulder press
- dumbbell lateral raise
- triceps pushdown
- Wednesday Squat and Deadlift 3×5 workout
- Thursday the same as Tuesday
- Friday Squat and Deadlift 3×5 workout.
Pyeloplasty – Final ThoughtsPyeloplasty is major surgery. Get the best surgeon you can, and Dr. Michael Stifelman is one of the best in the world. Don’t expect much nutritional advice, because he describes himself as a plumber. But, he will get back to you very promptly.
The Department of Urology at Hackensack University Medical Centeri9879876r9
What’s NextIf you ever have hydronephrosis of your kidneys, stay on top of it. And if you have two healthy kidneys today, go out now and dance in the fields or a park for your good fortune.
- Keep drinking water throughout the day,
- walk 30 minutes a day,
- eat real food,
- do pushups,
- squats, and
- deadlifts, and
- enjoy your life.
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