Postoperative Management

After surgery, the patient remains in the hospital till a solid diet is tolerated. With retroperitoneal surgery, oral intake can be resumed more rapidly, and hospital stay is usually overnight. With transperitoneal surgery, oral intake can usually be resumed once flatus is passed the next day. Rapid resumption of bowel activity can be facilitated by the use of nonopiate analgesia such as ketorolac.

The drain can be removed if output is less than 100 cc/day. Usually, the drain can be removed the next day. With transperitoneal surgery, the output can be exaggerated by peritoneal fluid. In such cases, checking drain fluid creatinine can be used to biochemically identify if urine leak is the cause of excessive drain output. Management of persistent urinary leakage are addressed below.

The patient returns for stent removal at four to six weeks. One month after stent removal, a diuretic renogram or intravenous pyelogram can be obtained to verify a good surgical result.

Management of urine leak is based on maximizing drainage, and urinary diversion. In the immediate postoperative period, placement or replacement of a Foley catheter can facilitate distal drainage.

0 0

Post a comment