What does the procedure involve?
This is a key-hole (laparoscopic) procedure to remove the kidney and the ureter, which is the tube through which urine passes from the kidney to the bladder. This operation is usually carried out to remove cancers involving the inner lining of the kidney or ureter. Sometimes the procedure is also recommended for a non-funtioning kidney if it is thought to be a source of chronic infection or pain.
What are the alternatives to this procedure?
Alternatives to this procedure include observation, radiotherapy, chemotherapy and open surgery.
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery.
You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
You will need to wear anti-thrombosis stockings during your hospital stay. These help prevent blood clots forming in the veins of your legs during and after surgery.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for warfarin, aspirin or clopidogrel (Plavix®).
- A previous or current MRSA infection.
What happens during the procedure?
A full general anaesthetic is normally used and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The anaesthetist may also use an epidural or spinal anaesthetic to reduce the level of pain afterwards.
A telescope and specialised surgical instruments will be placed through key-hole incisions into the abdominal cavity (pictured). The bowel is mobilised to reach the back of the abdominal cavity (retroperitoneum) where the kidney and ureter are situated. The kidney and ureter including their surrounding sheath of fat will be freed. The blood vessels to the kidney will be divided with a specialised stapling device. The lower ureter is disconnected from the bladder, usually using a separate 10cm incision in the lower abdomen. The kidney and ureter are then removed through this incision.
A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube may be placed down to the bed of the kidney.
What happens immediately after the procedure?
You will be given fluids to drink from an early stage after the operation. You will be encouraged to mobilise as soon as you are comfortable to prevent blood clots forming in your legs. The drain and catheter normally remain in place for up to one week in case urine leaks from the cut surface of the bladder.
The average hospital stay is seven days.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- Temporary pain in the tip of your shoulder.
- Temporary bloating of your tummy.
- Recurrence of disease elsewhere in the urinary tract, which requires repeated telescopic examinations of the bladder.
Occasional (between 1 in 10 and 1 in 50)
- Bleeding, infection, pain or hernia of the incision needing further surgery.
- Need for additional treatment for cancer after surgery.
Rare (less than 1 in 50)
- Entry into the lung cavity needing insertion of a temporary drainage tube.
- Recognised (or unrecognised) injury to organs/blood vessels needing conversion to open surgery (or deferred open surgery).
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death).
- The pathology in the kidney may subsequently be shown not to be cancer.
- Persistent urine leakage from the bladder needing prolonged catheterisation or further surgery.
What should I expect when I get home?
It will be at least 14 days before healing of the wound occurs and it may take up to six weeks before you feel fully recovered from the surgery. You may return to work when you are comfortable enough and your Surgeon or GP is satisfied with your progress. You may have persistent twinges of discomfort in the wounds, which can go on for several months.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your Surgeon or GP. Any other postoperative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
A clinic appointment will be made for you at 2 to 4 weeks after the operation.
You will usually need to undergo regular bladder inspections to check that the growth that involved your kidney does not return in the bladder lining.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.