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Nephrouretectomy

Procedure

What is Nephrouretectomy?

Nephroureterectomy is a minimally invasive surgical procedure to remove a patient's renal pelvis, kidney, ureter, and bladder cuff. It is usually performed to provide better survival for patients with transitional cell cancer.

What happens before a nephroureterectomy?

  • For 24 hours prior to surgery, you'll be asked to have a clear liquid diet. Dr. Raghunath’s team will ask you to not eat anything starting at midnight the night before your surgery. If you have medications you are instructed to take, take them with a small sip of water.
  • A week before surgery, doctor will advise you to discontinue certain medications and supplements that may increase the risk of bleeding during surgery.

 

What happens during a nephroureterectomy?

  • First, you'll be given general anesthesia to put you to sleep for this procedure.
  • The surgeon will isolate the kidneys and other organs to be removed from your body's blood flow. They kidney and ureter are then separated from the structures, which hold it in place. They are then extracted from a small incision.
  • Surgery takes approximately 3-4 hours, and the hospital stay is usually one to two days.

 

What happens after a nephroureterectomy?

  • After this procedure, you'll be taken to a recovery room and monitored for any potential complications. Once you wake up, you will be treated for pain and continue to be monitored. If you experience nausea, you will be given medication to help treat it.
  • For one to two days after surgery, you'll be given a liquid diet to help give your body time to recover and slowly transition you back to real food.
  • The day after surgery, you will be encouraged to get out of bed and walk around to limit the risk of blood clots in your legs, prevent pneumonia, and fasten the healing process. Full recovery usually takes two to three weeks.

 

What are the risks associated with this procedure?

Although rare, potential risks and complications with this operation include, but are not limited to, the following:

  • Bleeding
  • Infection
  • Adjacent tissue or organ injury
  • Incisional hernia

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Frequently Asked Questions

  • What are the advantages of laparoscopic nephroureterectomy over conventional nephroureterectomy?
    This minimally invasive nephroureterectomy has the advantage of improved cosmesis, reduced pain, blood loss, and hospital stay, as compared to conventional open surgery with similar cure rates. While open surgery may require 1-2 large abdominal or flank incisions, minimally invasive approaches involve 4 keyhole incisions in the abdomen.
  • Which patients are not good candidates for laparoscopic or robotic nephroureterectomy?
    Patients with very large tumors or tumors invading surrounding structures (e.g. vena cava, liver, and/or bowel) may be best served by an open approach due to the extent and need for adjacent organ resection. Patients with medical conditions such as severe lung and heart disease may not be able to tolerate a laparoscopic approach due to the need to undergo a general anesthetic.
  • What are the general precautions to take after nephroureterectomy?
    After you are discharged, you should avoid driving for two weeks after the procedure. It is very important for you to go slow for six weeks and not do any heavy lifting. Walking as exercise is possible and highly encouraged after surgery. Most patients are able to return to work after 4 weeks. Talk to Dr. Raghunath in detail regarding resuming work.
  • Will I need further treatment such as radiation or chemotherapy following surgery?
    For patients with low-grade, contained tumors, prognosis remains excellent as most are cured with surgery alone. Rarely, patients are found to have large, invasive cancers that may require adjuvant treatment with chemotherapy. These would be managed under advisement of a medical oncologist.