Discharge Instructions After a Ureteral Reimplant Repair

Definition of a ureteral reimplant repair

A ureteral reimplant repair fixes the ureters (tubes that connect the kidneys to the bladder). This helps stop urine from flowing backward from the bladder back into the kidneys (a condition called vesicoureteral reflux).

Diet

When can my child eat?
Your child may resume a normal diet after discharge from the hospital.

What should I do about nausea and vomiting?
Below are tips if your child has trouble with nausea and vomiting:

• Let your child’s stomach rest for 30 minutes. Then, return to clear liquids. Clear liquids include Sprite®, apple juice or water.
• When your child can keep clear liquids down, slowly work up to a normal diet.
• Have your child lay down or sit quietly

If the vomiting is persistent or continues, call your child’s care team for next steps.

How will I know if my child is drinking enough?
Dehydration can occur. Signs and symptoms of dehydration include:

• Dry mouth
• Lack of tears
• Not urinating for 6-8 hours or small amount of dark colored urine. Your child should have 6-8 wet diapers per day.

If your child has these symptoms call your doctor or bring your child to the closest emergency room.

How can I tell if my child is in pain?
Your child’s care team wants your child to be comfortable, although no surgery is pain free. Some children can tell you about their pain. For all children, it is important to offer comfort and listen to their concerns.

Other ways children communicate they are in pain include:

• Moaning
• Whimpering
• Making faces of pain
• Crying
• Irritability
• Being inactive
• Having no appetite
• Not sleeping

How can I tell if my child needs pain medicine or other medicines?
If your child is experiencing pain, you can give them medicine. If it is not time for the medicine, try other ways to control pain such as:

• Watching a favorite show
• Ice packs
• Play games

If these do not work, call your child’s care team to see if changes in the dose or type of medication are needed.

What medicines does my child need?
Acetaminophen alternating with ibuprofen should be given every 4 hours for the first 24 hours after surgery. These are over the counter medications. Sometimes your doctor will want you to give ibuprofen every 8 hours. Please ask your child’s nurse. Your child does not need to be awakened to keep the dosing schedule.

In addition to over-the-counter medications, your child’s care team may prescribe a stronger medication may be prescribed as needed. If these medications do not help, call your child’s care team and ask to speak to the nurse. If you call outside of normal business hours, call MGfC at 617-726-2000 and ask the operator to page the pediatric urology resident on call.

Bandage/wound care

How should I care for the wound?

• Remove the gauze dressing over the incision one day after surgery. Beneath the incision are usually small SteriStrips™ (small white strips that help close the edges of the wound) that help support the incision. These remain in place for about 1-2 weeks. After that, they can be removed as they start to naturally peel off the skin.
• The incision will appear red, slightly raised and swollen. This is normal. The stitches are beneath the skin and will dissolve on their own. They do not have to be removed.
• It is normal for small amounts of dried blood to be present. Once the Steri-Strips™ come off, take care of the incision just like normal skin.
• There may be adhesive that remains on the skin after the bandages come off. Adhesive remover from your local drug store or grocery store can help remove the adhesive.

How much drainage is normal?
Swelling and bruising around the incision is expected. A small amount of fluid or bloody drainage is common but if the incision is dripping blood you should apply pressure and call your doctor.

Bathing/showering

When can my child take a bath or shower?

• Your child can take a sponge bath for the first day after surgery. They can take a regular bath or shower 48 hours (2 days) after surgery.
• Simply pat the incision dry with a towel. This allows the Steri-Strips™ to dry before dressing.
• If a stent tube is in place, take only short showers or sponge baths until the tube is removed. The tube is stitched in and secured to the skin with tape.

Activity

How active can my child be?

• Anesthesia can make your child feel groggy or sleepy. For the first the day, your child should not do any activities that require balance such as bike riding, playground equipment, scooters, etc. After this, your child can do normal activities safely and carefully.
• If your child is using a prescription pain medication (such as Oxycodone, Lortab® or hydrocodone), they can become sleepy or dizzy. Watch your child to prevent them from falling.

Behavior

What is normal behavior after surgery?
It is very normal to see behavior changes after surgery. Most changes in behavior only last a few days to 2 weeks. If they last longer than 3-4 weeks, call your child’s care team.

Some examples of changes include:

• Regression (acting like a younger child, such as bedwetting or acting out)
• Changes in sleeping and eating patterns, or nightmares.

Being patient with your child will help reduce these changes. Comfort your child and help them feel safe. Understand that your child has been upset by surgery.

What to watch for

What if my child has a fever?
Mild fevers are common after surgery. If the fever is above 102° F (38.8° C) for more than 24 hours after surgery, please call your child’s care team.

How can I tell if the wound is infected?
An infected wound might show the following signs:

• If the wound becomes increasingly red
• Pain when touched
• Looks like it is opening up
• Draining fluid or pus
• Increased swelling

If your child has any signs of infection, call their care team.

How can I tell if my child’s urination is normal?
Here are signs to tell if your child’s urination is normal:

• If your child urinates the same amount every day
• If your child has some pain with urination (caused by particles from the ureters and bladder being flushed out)
• Blood in the urine on and off for the first 1-2 weeks

Call your child’s doctor if your child has any of the following during urination:

• Amount of urine has greatly decreased
• Pain increases greatly or changes
• If your child passes large sized blood clots on two consecutive urinations (two urinations in a row)

What if my child has uncontrolled pain?
If your child’s pain cannot be controlled with medication or other pain management methods, call the care team for other recommendations.

What if my child becomes constipated or has diarrhea?

• Pain medications can cause constipation. If your child has not had a normal bowel movement in 3 days, please call the care team.
• To help ease constipation, give your child lots of fresh fruits and vegetables and fluids.
• If your child has diarrhea, return to soft, easily digested foods and encourage them to drink lots of fluids. This can help replace the loss of fluids from diarrhea.
• If the diarrhea continues for 24 hours, call the care team for next steps.

Whom to call

Please call Pediatric Urology at 617-724-0327 between 8:30 a.m. and 4:30 p.m. Monday through Friday.

If the office is closed, please call MGfC at 617-726-2000. Ask the operator to page the pediatric urology resident on call.

If there is an emergency, go to the nearest emergency room.

Follow-up appointment

Before discharge from the hospital, the care team will let you know when to come back for a follow-up appointment. Please schedule the appointment with the front desk staff before you leave the hospital. If your child has a stent tube in place, please let the front desk staff know so they can schedule another follow-up appointment as instructed. Thank you for letting us share in the care of your child.

Special instructions

Go to the closest emergency room or call 911 if your child has any of the following signs:

• Chest pain
• Shortness of breath
• Difficulty breathing
• Excessive bleeding
• If you cannot arouse or wake up your child

A note for when you are on the way home…

Observe your child during the ride home. They may sleep but their head and neck should not fall or slump forward. This may cause their airway to become blocked or cause difficulty with breathing. Your child should be in a child safety seat with proper restraints.

Rev. 7/2020. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.