Nephrectomy

What is a nephrectomy?

Nephrectomy is a procedure to remove all or part of one kidney. This can be performed to remove a diseased or cancerous kidney, or a healthy kidney in the case of living donor kidney transplants.

Types of nephrectomy

There are two main types of nephrectomies:

• Complete (or radical) nephrectomy. Your surgeon removes the entire kidney and additional structures, such as your ureter (the tube that connects the kidney to the bladder), adrenal gland or lymph nodes.
• Partial nephrectomy. Your surgeon removes only the diseased kidney tissues and leaves the rest of your kidney in place.

If you suffer from kidney cancer and the size of your tumour is large (more than 7cm), centrally located, or both, your best option may be to have the whole kidney removed, depending on your discussion with your surgeon.

However, if you have compromised renal function (e.g. you have only one kidney), your surgeon might suggest to remove only the affected parts of the kidney.

If both kidneys are removed, that is known as bilateral nephrectomy.

Surgical techniques for nephrectomies

Nephrectomies can be done using either one of the following two methods.

• Open nephrectomy, where the surgeon makes one large incision on your abdomen to access your kidney
• Laparoscopic nephrectomy, where the surgeon makes a series of small incisions in your abdomen using a camera and small instruments

Due to its minimally invasive nature, laparoscopic nephrectomy is becoming a popular option.

Why do you need a nephrectomy?

You may need a nephrectomy to remove all or part of your kidney if it:

• Has a tumour, which may be either cancerous or non-cancerous
• Has an infection
• No longer functions (kidney failure)

If you are donating a kidney to an end-stage kidney failure patient, your doctor will perform a nephrectomy to remove it.

Who should not undergo nephrectomy?

Your doctor will discuss their concerns with you if they feel a nephrectomy is unsafe for you.

What are the risks and complications of a nephrectomy?

Nephrectomy is generally a safe procedure. As with any surgery, it carries the potential risks of:

• Bleeding
• Infection
• Injuring other internal organs

Post-nephrectomy, there is a chance you may experience the following due to reduced kidney function.

• High blood pressure (hypertension)
• Chronic kidney disease

How do you prepare for a nephrectomy?

Your surgeon will likely instruct you to fast from food and drinks the night before the procedure.

You should inform your surgeon on any medications that you are currently taking in case they need you to stop or reduce dosage in the days leading up to your surgery.

You will also have blood samples taken so that your medical team can record your baseline kidney function and blood cell count.

What can you expect in a nephrectomy?

Removing part or all of your kidney is a very serious procedure. Your doctor will recommend it only as a last resort to protecting your health.

Most of us are born with two kidneys, but we can usually function with only one. Unless you need both kidneys to be removed, a nephrectomy to remove part or the whole of one kidney can boost your kidney health in the long-term.

Estimated duration

A nephrectomy typically takes 3 – 5 hours, depending on the complexity of your tumour.

Before the procedure

You will be given general anaesthesia so that you will remain asleep throughout the surgery. You will also have a urinary catheter to drain urine from your bladder before the surgery.

During the procedure

If your surgeon is performing a laparoscopic nephrectomy, they will:

• Make one or a few small incisions in your abdomen.
• Insert a small camera attached to a wand through the incisions.
• Use the camera image to navigate small surgical tools through the incisions to remove either the diseased tissues in your kidney or the entire kidney.
• Close all incisions with small stitches.

If your surgeon is performing an open nephrectomy, they will:

• Make one incision in your abdomen.
• Remove the diseased tissues in your kidney or the entire kidney.
• Close the incision with stitches.

For complete nephrectomy, your surgeon may also remove the adrenal gland which sits above the kidney if the tumour is close to it. In some cases, your lymph nodes or other tissues may be removed as well.

After the procedure

You will remain in hospital for close observation. You will have to continue wearing the urinary catheter for several days while your body recovers from the procedure.

After the anaesthesia has worn off, you will likely feel soreness around your incision sites. You will be given painkillers to manage the pain. You may also find it uncomfortable to take deep breaths as the incisions will be near your diaphragm, which is the muscle under your lungs.

Care and recovery period for a nephrectomy

You must avoid strenuous activity or doing any heavy lifting for several weeks after your nephrectomy.

As your body recovers, your kidney may begin to function normally and you may resume your usual routine and activities. Nonetheless, to protect your remaining kidney from deteriorating, your doctor may recommend the following lifestyle changes.

• Eating healthy food
• Exercising regularly
• Attending regular check ups to monitor your kidney health
• Avoiding high-contact sports that may increase your risk of kidney injury

You will also need to undergo urine screening tests (urinalysis) and blood tests at least once a year to monitor your kidney health.