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VNA of Care New England

Nephrectomy

(Kidney Removal)

Definition

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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • 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
Long-term complications from decreased kidney function may include:
  • High blood pressure
  • Chronic kidney disease
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

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 medications. You may be asked to stop taking some medications up to one week before the procedure, like:
  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets
Do not eat or drink after midnight before the procedure. You may need to take medication to cleanse your bowels.

Anesthesia

General anesthesia will be used. You will be asleep during the procedure.

Description of Procedure

A tube called a catheter will be inserted into your bladder. 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 tube from the kidney to the bladder is known as the ureter. If the whole kidney is being removed, the ureter and blood vessels will be cut before kidney will then be removed. If only part of the kidney is removed the ureter and blood vessels will be kept. 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 surgery. Pain and discomfort after the procedure can be managed with medications.

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 medication will be given after surgery. Blood pressure, electrolytes, and fluid balance will all be carefully monitored to evaluate kidney function. 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.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
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 wil be necessary.

Call Your Doctor

Call your doctor if any of the following occur:
  • Signs of infection, including fever or chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medications you have been given
  • Difficulty urinating
  • Sudden weakness
If you think you have an emergency, call for medical help right away.

RESOURCES

National Cancer Institute http://cancer.gov

National Institute of Diabetes and Digestive and Kidney Diseases http://www.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, 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.

Dunn MD, Portis AJ, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol. 2000;164(4):1153-1159.

Fabrizio MD, Ratner LE, et al. Laparoscopic live donor nephrectomy. Johns Hopkins website. Available at http://urology.jhu.edu/surgical%5Ftechniques/nephrectomy/index.html. Accessed May 23, 2013.

Kidney cancer. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=24. Updated March 2013. Accessed May 23, 2013.

Park YH, Byun SS, 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 http://www.ebscohost.com/dynamed: 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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