• Nephrectomy

    (Kidney Removal)

    Definition

    In a radical nephrectomy, the whole kidney is removed. In a partial nephrectomy, only a piece of the kidney is removed.

    Reasons for Procedure

    Kidney removal may need to be done because of:
    • Birth defects
    • Injuries to the kidney
    • Infection
    • Tumor
    • Kidney donation for a transplant

    Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have a nephrectomy, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Blood clots
    • Damage to nearby organs
    • Reactions to the anesthesia
    • Leakage of urine from the remaining kidney tissue, if only part of the kidney is removed
    Factors that may increase the risk of complications include:
    • Smoking
    • Prior kidney surgery
    • Obesity
    • Alcoholism
    • Poor nutrition

    What to Expect

    Prior to Procedure

    Your blood type is checked. This is done in case a transfusion is needed before or after surgery.
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel or warfarin
    Do not eat or drink after midnight before the procedure. You may need to take medicine to cleanse your bowels.

    Anesthesia

    General anesthesia will be given. You will be asleep.

    Description of Procedure

    A catheter (tube) will be inserted. An incision will be made in the abdomen or side of the abdomen. A rib may need to be removed to access the kidney. The ureter (tube from the kidney to the bladder) and blood vessels will be cut if the whole kidney is being removed. The kidney (or part of the kidney) will then be removed. The incision will be closed.
    Kidneys, Ureters, and Renal Blood Vessels
    The Urinary System
    Copyright © Nucleus Medical Media, Inc.
    Laparoscopic surgery may also be used for a nephrectomy. The abdominal cavity will be inflated with gas. Several keyhole incisions are made in the area. A laparoscope, a long tool with a camera on the end, will be inserted through one of the holes. This allows the doctor to see inside you. Tools will be inserted through the other holes to perform the surgery. The same steps will be used to detach the kidney. A small incision will be made to remove the kidney.

    How Long Will It Take?

    Between 2-4 hours

    How Much Will It Hurt?

    Anesthesia will prevent pain during the surgery. Recovery is usually painful because of the location of the incision. The laparoscopic approach is much less painful. Your doctor will give you medicine to manage the pain.

    Average Hospital Stay

    The typical hospital stay after a nephrectomy is 2-7 days. The exact length depends on the type of surgery. Your doctor may choose to keep you longer if complications occur.

    Post-procedure Care

    At the Hospital
    IV fluids and pain medicine will be given after surgery. Blood pressure, electrolytes, and fluid balance will all be carefully monitored. A urinary catheter is often needed for a short time following surgery.
    You will be encouraged to move around and be cautiously active as symptoms allow.
    At Home
    Avoid difficult exercise or activities for about six weeks. Be sure to follow your doctor's instructions. Ask your doctor about when it is safe to shower, bathe, or soak in water.
    If both kidneys are removed, hemodialysis or kidney transplantation is necessary.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever or chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which last for more than two days after you leave the hospital
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    • Unable to urinate
    • Sudden weakness
    In case of an emergency, call for medical help right away.

    RESOURCES

    National Cancer Institute http://cancernet.nci.nih.gov/

    National Institute of Diabetes and Digestive and Kidney Diseases http://www2.niddk.nih.gov/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Kidney Foundation of Canada http://www.kidney.ca/

    References

    Andersen MH, Mathisen L, Oyen O, et al. Postoperative pain and convalescence in living kidney donors—laparoscopic versus open donor nephrectomy: a randomized study. Am J Transplant . 2006;6(6):1438-1443.

    Bartlett ST, Schweitzer EJ. Laparoscopic living donor nephrectomy for kidney transplantation. Dialysis & Transplantation .1999;28(6):318-331.

    Campbell M, Wein A, Kavoussi L. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: WB Saunders; 2007.

    Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol . 2000;164(4):1153-1159.

    Fabrizio MD, Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy. Johns Hopkins website. Available at http://urology.jhu.edu/surgical%5Ftechniques/nephrectomy/index.html#button3 . Accessed December 14, 2012.

    Kidney Cancer. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=24 . Updated January 2011. Accessed December 14, 2012.

    Park YH, Byun SS, Kang SH, et al. Comparison of hand-assisted laparoscopic radical nephrectomy with open radical nephrectomy for pT1-2 clear cell renal-cell carcinoma: a multi-institutional study. J Endourol . 2009;23(9):1485-1489.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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