What is an open nephroureterectomy?
Open nephroureterectomy is an operation where the kidney and ureter (tube draining urine from the kidney into the bladder) are removed using in an open incision in the upper abdomen. The whole ureter is removed either using a telescope or with a separate incision in the lower abdomen. Dr Nathan will usually remove a kidney using key-hole (laparoscopic) surgery due to quicker post-operative recovery, However, in complex cases open nephroureterectomy may be recommended if key-hole surgery is not thought to be feasible.
What are the alternatives to this procedure?
Alternatives to this procedure include observation, radiotherapy, chemotherapy and laparoscopic 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 a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
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.
The surgeon will usually remove your kidney through an incision in your loin. On occasions, the incision is made in the front of the tummy or extended into the chest area.
You may require a second incision in the lower part of the tummy to detach the ureter from the bladder although this detachment can be done with a telescope passed into the bladder.
A bladder catheter is normally inserted post-operatively, to monitor urine output. A drainage tube is usually placed into the bed of the kidney.
Occasionally, it may be necessary to insert a tube through your nose, especially if the operation was particularly difficult, to prevent bloating of your stomach.
What happens immediately after the procedure?
You may be monitored for a day or two in the high dependency unit or ICU. You will normally have a drip in your arm and, occasionally, a further drip into a larger vein in your neck.
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 7-10 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 bloating of your tummy.
- Recurrence of disease elsewhere in the urinary tract, which requires repeated telescopic examinations of the bladder.
- Bulging of the wound due to damage to the nerves in the abdominal wall (if a loin approach has been used).
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.
- Entry into the lung cavity needing insertion of a temporary drainage tube.
Rare (less than 1 in 50)
- Involvement or injury to nearby local structures (blood vessels, spleen liver, lung, pancreas and bowel) needing more extensive 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 6-8 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.