Information regarding your Nephrectomy

What is it? 

 

Removal of a kidney;  the important structures are the kidney, blood vessels connected to the kidney and the ureter ( tube draining urine to the bladder). Two kidneys are not essential for survival. In fact less than one kidney is all that is necessary.

Radical Nephrectomy

This is the removal of the whole kidney including the fatty tissue around the kidney + or – attached adrenal gland and lymph nodes.  This is the most common surgery performed for cancer of the kidneys.

Simple Nephrectomy

Removal of the kidney only without the surrounding fat and is often used for non-cancerous conditions of the kidney.

Partial Nephrectomy

This is the removal of only a part of the kidney. This is used when removal of the entire kidney would result in the patient requiring dialysis.  This may occur if both kidneys have a tumour or if the other kidney is not functioning.  This procedure may also be used if the tumour is small and clearly separated from the majority of the kidney.

Anatomy & Physiology

The kidneys are a pair of bean shaped reddish-brown organs that lie on either side of the spinal column.  The kidneys filter the blood waste products that pass into the urine.  The urine then passes from the kidneys and then into the renal pelvis and into the ureter, which conducts the urine into the bladder.

On the upper surface of each kidney lies the adrenal gland; a small pyramid shaped gland that produces steroid hormones and adrenaline.  A capsule of thin tissue encloses each kidney and the adrenal gland this is called Gerota’s fascia.  It is separated from the capsule of the kidney by the perinephric space, which contains fat.

 

Why is a Nephrectomy done?

 

Cancer or suspected cancer of the kidney or ureter.

Non-functioning kidney due to obstruction, infection or stones.

 

Before Surgery (Pre-op)

• Blood and urine tests are done
• X-ray studies of kidneys  ( ultra sound or CT Scans)
• Chest x-rays
• Cystoscopy/ ureteroscopy (may be required) - a look into the bladder
  +/or- ureter with a small telescope with a light and fibre optics to see the tumour in place and may also allow for biopsy.
• It is very important that you bring your x-rays to hospital with you.
• Bring your own medication to hospital with you also.
• Please inform Dr Bourne and nursing staff if you are allergic to any medications tapes or solutions ( such as iodine).
• Please see the attached medication list and discuss with Dr Bourne prior to your hospital admission medications which may need to be with held prior to admission particularly Aspirin/ Arthritis medication or Warfarin.
• The anaesthetist will see you before the operation.
• You will be told when to stop eating and drinking prior to the operation.

How is it done?

• -An incision is made usually on the left or right side below the ribs but sometimes in the flank along the line of the ribs.
• The artery leading to the kidneys is located, isolated and tied.
• The ureter is located tied and cut away from the kidney.
• The vein that drains blood from the kidneys is divided.
• The kidney is freed of adhesions or adjoining connective tissue and removed.
• All disconnected blood vessels are tied and the muscles are closed with sutures. The skin is closed with sutures or clips.

Complications/Risks

• Excessive bleeding
• Surgical wound infection
• Inadvertent injury to other organs near the kidney i.e.; large bowel, small bowel, spleen, liver.
• Blood clots in the legs or a pulmonary embolism ( clot in the lungs).
• Chest Infections.
• Anaesthetic Risks.
• Ileus ( temporary loss of bowel function ).
• Temporary loss of renal function of the other kidney.

After the Nephrectomy (Post-Op)

• The operation may take 2.5 to 4hrs.
• Following the nephrectomy the patient’s output of urine is monitored to be sure it is adequate. You will have a catheter in your bladder to monitor urine output.
• Function of the kidney is monitored with blood and urine tests to determine if it is satisfactory.
• You will have a dressing over the incision area. You may also have a tube leading from your wound that will be attached to a suction bag. This tube will drain excess bleeding from around the incision.
• You will not be allowed to eat or drink until Dr Bourne sees you the morning after your operation.  Then a clear liquid diet is usually required until the bowel begins to function again.  After a few days a well balanced diet to promote healing is ordered.
• Moving and elevating your legs often while resting in bed helps to decrease the likelihood of clots in the legs and lungs. You will have leg stockings in place and you will be given injections to help prevent clots.    The earlier you mobilise the better the chances are of preventing any post-operative complications.
• A physiotherapist will see you to assess your chest and circulation and to teach you some deep breathing and leg exercises.
• Bathe and shower with assistance and guidance from nursing staff.  The dressing is removed after a few days, after that you may wash the incision with a mild soap.
• Regular pain relief will be prescribed after either your epidural or Patient Controlled Analgesia (PCA) has been removed.  Nursing staff will ask questions about your pain.  It is important that you tell nursing staff of any pain you have so that appropriate relief may be given.
• Stool softeners can be given to prevent constipation.
• Resuming daily activity as soon as possible can also help the healing process.  You will be encouraged to walk around the ward as soon as you can. You will probably experience some pain, this is normal.
• Do not resume driving for 4 weeks after returning home.
• Avoid vigorous exercise and heavy lifting for 6wks after surgery.
• Average hospital stay is approximately 7-10 days.
• If you require a medical certificate for work, ask Dr Bourne for this before you go home.
• If Dr Bourne has commenced you on any new medications please ask if you have any queries about them.
• You will receive an appointment with Dr Bourne in his rooms for approximately 4weeks time.
• After discharge you may be reviewed for evidence of tumour recurrence.  This is usually done at 6month intervals for 4-5yrs.

Please Notify us or present to hospital if:

• Pain, swelling, redness, drainage or bleeding increases in the surgical wound area.
• You develop signs of infection such as headache, muscle aches, dizziness or general ill feeling and / or fever.
• You experience nausea, vomiting, or abdominal swelling or swelling of the legs.

CONCLUSION

This is not intended to be an exhaustive summary of your operation. Please do not hesitate to ask Dr Bourne if you have any questions or concerns.

 

PLEASE READ THE IMPORTANT INFORMATION BELOW REGARDING MEDICATION

 

Stop the following TWO WEEKS prior to admission:-

 

Action Aggrastat Alka-Seltzer Any Aspirins Arixtra Asasantin Aspalgin Aspirina Aspro Clear Aspro Tabs & Capsules Astrix

Bayer Aspirin Bex tablets & Powders Cartia Cardiprin Codiphen Forte Codis Morphalgin Codral Forte Codox Decrin Powder Disprin Disprin Forte

Ecotrin Iscover Persantin Plavix Solcode Solprin Spren Veganin Vincents Tabs & Powders Winsprin

 

Stop the following SEVEN DAYS prior to admission:-

Anti-inflammatory drugs:

 

Acliln ACT-3 Actriprofen Arthrexin Brufen Butazolidin Celebrix Clinoril Clunisol Declofenac Diflunisal Dolobid Fledene Feldene-D Fenac Ibuprofen

Indocid Indomed Indomethacin Inza Ketoprofen Ketoralac Mefenemix Acid Mefic Mobilis Mobilis-D Naprogesic Naprosyn Naproxen Nurofen Orudis Oruvail

Phenylbutazone Piroxicam Ponstan Proxen Rafen Sulindac Surgam Tenoxicam Tiaprofenic Acid Tilcotil Toradol Voltaren Vioxx

 

ANTICOAGULANTS

 

If you are taking MAREVAN, DINDEVAN OR WARFARIN, TICLID, TICLOPIDINE, COUMADIN take half dose for ONE day, FIVE days before the operation, then stop the tablets FIVE days before the operation. Discuss this with your Physician, as some patient Need Heparin injections when they cease taking these tablets. The tablets should not be resumed until TWO weeks after the operation, unless otherwise advised by your Physician or Surgeon.

 

Panadol, Panadeine or Digesic may be taken for pain relief.

 

PLEASE ENSURE DOCTOR IS AWARE OF ALL DRUGS, PILLS, MEDICATIONS ON OR OFF PRESCRIPTION THAT YOU TAKE, EVEN IF THEY ARE NOT ON THE ABOVE LIST.