Nephroureterectomy
The Procedure
This procedure is performed to remove the kidney (and surrounding fat) for suspected cancer of the inner lining of kidney or ureter. The whole ureter is removed either using a telescope or with a separate incision in the lower abdomen.
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain postoperatively.
The kidney is usually removed using laparoscopic or keyhole technique. A separate incision is usually made in the lower part of the abdomen to enable the lower end of the ureter to be completely removed
A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is usually placed through the skin into the bed of the kidney.
Occasionally, it may be necessary to insert a stomach tube if the operation was particularly difficult, to prevent distension of your stomach.
After the operation, you may remain in the Special Recovery area of the operating theatres before returning to the ward. You will normally have a drip in your arm.
We will encourage you to mobilise as early as possible and to take fluids or flood as soon as you are able.
The average hospital stay is 5-7 days.
Most procedures have a potential for side-effects and these are outlined below.
Common (greater than 1 in 10)
- Temporary insertion of a bladder catheter and wound drain
- Recurrence of disease elsewhere in the urinary tract which requires regular telescopic examinations of the bladder for follow-up
Occasional (between 1 in 10 & 1 in 50)
- Bleeding requiring further surgery or transfusions
- Entry into the lung cavity requiring insertion of a temporary drainage tube
- Need for additional treatment for cancer after surgery
- Infection, pain or bulging of the incision site requiring further treatment
Rare (less than 1 in 50)
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
- Involvement or injury to nearby local structures (blood vessels, spleen liver, lung, pancreas and bowel) requiring more extensive surgery
- The histological abnormality in the kidney may subsequently be shown not to be cancer
- Persistent urine leakage from the bladder requiring prolonged catheterisation or further surgery
It will be at least 14 days before healing of the wound occurs but it may take up to 6 weeks before you feel fully recovered from the surgery.
You may return to work when you are comfortable enough and your specialist is satisfied with your progress.
Many patients have persistent twinges of discomfort in the loin wound which can go on for several months.
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.
Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
It will be at least 14-21 days before the pathology results on your kidney are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further
treatment decisions are made. You and your doctor will be informed of the results after this discussion.
Once the results have been discussed, it may be necessary for further treatment but this will be discussed with you by your Consultant or Specialist Nurse.
You will usually need to undergo regular bladder inspections to check that the growth that involved your kidney is not affecting the bladder lining.
