Nephrectomy Questions

What is a nephrectomy?

Nephrectomy is the name for a surgical procedure to remove the kidney.

What types of nephrectomy are there?

This can refer to how much of the kidney is removed:

  • Partial: only a small amount of the kidney is remed
  • Simple: the whole kidney is removed
  • Radical: the whole kidney, surrounding fat and sometimes the adrenal gland also
  • Nephroureterectomy: the kidney and its ureter, which is the tube that carries urine from the kidney down to the bladder
  • Donor: a kidney with its blood vessels and ureter is removed to give to another person.

...and to whether the operation is performed by traditional open means or by newer, key hole approaches (laparoscopic nephrectomy).

Why would you want to remove a kidney?

Kidneys are removed because of

  • cancer
  • poor function associated with recurrent urinary tract infection or stones
  • kidney transplantation
  • serious kidney disease

Are there different ways to perform a nephrectomy?

A kidney is removed either through a large skin incision necessary for traditional open surgery or by minimally invasive surgery - laparoscopic nephrectomy. There are significant advantages for laparoscopic nephrectomy over traditional surgery. Recently, it has become possible to destroy small tumours by freezing (cryoablation) without removing them surgically.

Can you function normally with one kidney?

The kidneys are part of the urinary system, and are just above the level of the waist in the back. In general, there are two kidneys but not always. Their main purpose is to clean the blood and get rid of toxins in the urine. Fortunately, kidney cancer usually affects only one organ. People can function well with just one kidney if a one needs to be removed. In a few cases where overall kidney function is not so good, minor dietary restrictions may be recommended. In rare cases, lifelong dialysis or a kidney transplant may be needed.

How is a nephrectomy performed?

In traditional open surgery, the anaesthetist gives a general anaesthetic and the surgeon makes an incision on the side or front of the abdomen or sometimes through the ribs and chest. Muscle, fat, and tissue are mobilised or divided to expose the kidney. The blood vessels supplying the kidney are tied or clipped and then divided. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The ureter is tied off, the kidney removed and the incision is sewn up (sutured). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.

However, it generally takes five to six hours from the time you leave the ward until you arrive in the recovery room. You will be unable to see your family for an additional two hours whilst patients are in recovery.

A laparoscopic nephrectomy is performed differently from open surgery and has significant advantages. Please see laparoscopic nephrectomy.

Will I need to be in the Intensive Care Unit (ICU) or High Dependency Unit (HDU)?

A short time in a high monitoring environment such as a high dependency unit (HDU) or intensive care unit (ICU) is usual after nephrectomy. The length of time necessary increases if there is underlying medical unfitness or complex surgery.

What are the risks of nephrectomy?

Every operation has some risk. A nephrectomy should be performed if the advantages outweigh the disadvantages and this most importantly relates to quality of life.

Potential problems include bleeding requiring blood transfusion, infection of the wound or lungs, injury to surrounding tissues (i.e. intestines, liver, spleen, pleura), the need for further procedures, blood clots, and the risks of anaesthesia (heart attack, stroke, blood clots, and death). Kidney failure is always a possible outcome, although rare.

Some operations may have specific additional complications. These include urine leakage, significant bleeding or tumour recurrence after partial nephrectomy.

What limitations will I have after I go home?

During your first week at home you should take it very easy. The onset of pain should be the guide to limiting your activities. After one week, you should gradually be able to increase the level of your activity until returning to work six weeks after open kidney surgery. During this period you should avoid vigorous exercise and lifting heavy objects.

How much time off work is necessary?

Most people recover quite rapidly from their surgery. Some begin working after only a few days or weeks. Nonetheless, because recovery can be variable, you should forewarn your employer that you will be absent from your job for two to four weeks after laparoscopic nephrectomy and six weeks after open kidney surgery.

How important is the delay between diagnosis and nephrectomy for kidney cancer?

The speed at which kidney cancer grows varies from person to person. A few weeks between a diagnosis of cancer and surgery is usually insignificant as the cancer has probably been present for some time and rarely advances significantly within a short period. Nevertheless, a nephrectomy should be performed as soon as it is safe providing it is appropriate if kidney cancer is diagnosed.

When can I travel after a nephrectomy?

Sometimes blood clots can develop in the leg veins which can sometimes be dangerous after a nephrectomy and so it is prudent to wait at least three weeks after a nephrectomy before flying. Otherwise, the major limitations to travel involve physical discomfort.