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Nephrectomy by Diana Kohnle

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Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

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

Complications are rare, but no procedure is completely free of risk. If you are planning to have a nephrectomy, your doctor will review a list of possible complications, which may include:

Infection
Bleeding
Blood clots
Damage to near-by organs
Reactions to the anesthesia
Leakage of urine from the remaining kidney tissue, if only part of the kidney is removed

What to Expect

Prior to Procedure

Your blood type is checked. This is done in case a transfusion is needed either before or after surgery.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Do not eat or drink after midnight before the procedure. You may need to take medicine to cleanse your bowels.

Anesthesia

General anesthesia will be given. You will be asleep.

Description of Procedure

A catheter will be inserted. 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 ureter (tube from the kidney to the bladder) and blood vessels will be cut if the whole kidney is being removed. The kidney (or part of the kidney) will then be removed. The incision will be closed.

Kidneys, Ureters, and Renal Blood Vessels

Laparoscopic surgery may also be used for a nephrectomy. The abdominal cavity will be inflated with gas. Several key-hole 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 retrieve the kidney.

How Long Will It Take?

Between 2-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during the surgery. Recovery is usually painful because of the location of the incision. The laparoscopic approach is significantly less painful. Your doctor will give you medicine to manage the pain.

Average Hospital Stay

Typical hospital stay following nephrectomy is 2-7 days. The exact length depends on the type of surgery. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

IV fluids and pain medicine will be given following the surgery. Blood pressure, electrolytes, and fluid balance will all be carefully monitored. 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.

At Home

Avoid strenuous exercise or activities for approximately six weeks. Be sure to follow your doctor's instructions .

If both kidneys are removed, hemodialysis or kidney transplantation is necessary.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever or chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Are not able to urinate
Sudden weakness

In case of an emergency, CALL 911 .

RESOURCES:

National Cancer Institute http://cancernet.nci.nih.gov/
National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Health Network http://www.canadian-health-network.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

Andersen MH, Mathisen L, Oyen O, Edwin B, Digernes R, Kvarstein G. 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.
Campbell M, Wein A, Kavoussi L. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: WB Saunders; 2007.
Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol . 2000;164(4):1153-1159.
Fabrizio MD, Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy. Johns Hopkins website. Available at http://urology.jhu.edu/surgical_techniques/nephrectomy/index.html#button3 . Accessed November 10, 2009.
Kidney Cancer. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/ . Accessed November 10, 2009.
Park YH, Byun SS, Kang SH, 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.

Last reviewed November 2009 by Adrienne Carmack, MD

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