Nephrectomy

What is Kidney Cancer & When is Nephrectomy performed?:
When new cells do not form when needed and old cells do not die when they should, then this deformity in the kidney turns into either benign tumors (not life-threatning, removed easily) or malignant tumours (spread easily, recoccur, life-threatening).
However, if detected at early stages, easily curable. Now-a-days, treatments are available even for later stage kidney cancers.
For the following stages of kidney cancer, nephrectomy is performed.
Stage I: Cancer cells limited to kidney. Size of tumor – 7cms (2 ¾ inches )
Stage II: Cancer cells limited to kidney. Size of tumor – more than 7cms.
Stage III: Tumor spread to any one of the following:
A nearby lymph node.
A adrenal gland, and beyond but limited to the protective layer of fatty and
fibrous tissues.
A nearby lymph as well as nearby main blood vessel of the kidney.

Safety:

As safe as traditional open surgeries. Minimal blood loos, pain, blood transfusion, only overnight hospital stay.

Length Of The Surgery:

Depends on the type of Nephrectomy performed

When to approach your Urologist?:

  • Blood passing through urine.
  • Constant fevers without any known source of infection.
  • Frequent pain in the lower back, waist or abdomen.
  • Sudden weight loss.
  • Early fatigue.
  • Formation of abdominal lumps.
  • Loss of appetite.
  • Pertaining swelling of ankles and legs.
  • At later stage of cancer:
  • Shortness of breath
  • Coughing up blood
  • Bone pain

Types Of Kidney Cancer:

Transitional cell carcinoma, cells in certain part of a kidney (almost always in the tubular linings) turn malignant, and begin to spread and start form a tumor.
Hypernephroma/ adenocarcinoma, is the kidney cancer type that is seen commonly in adults mostly above 40 years of age.
In children, Wilms tumor is seen to commonly occur.

Kidney Cancer Diagnosis:

  • Physical examination
  • Urine tests
  • Blood test
  • Intravenous Pyelogram (IVP)
  • CT scan
  • Ultrasound test:
  • Biopsy
  • Surgery

Treatment For Kidney Cancer:

Nephrectomy surgery is used to treat the renal cancers by organ removals.

  • Radical (Complete) nephrectomy: In this type of nephrectomy, the entire kidney is removed.
  • Partial nephrectomy: In such cases, only the diseased or affected tissue from the kidney is removed. The healthy tissue is kept intact.

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • The urine culture analysis should be negative.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of history severe lung/ heart conditions, blood pressure, diabetes, it is advisable not to perform nephrectomy on the patient.

Nephrectomy Procedure:

  • Nephrectomy is carried out under general anaesthetic.
  • A urinary catheter is inserted to drain the bladder of the urine.
    Types of Nephrectomy Surgeries:
  • Open surgery: An incision about 25 to 35 cms is made in the abdomen or on the side between lower ribs near the affected kidney area. For a better access to the kidney, lower rib may have to be removed.
  • Laparoscopic surgery: A few incisions (very small) are made in the abdomen and small surgical tools with a video camera are inserted. A slightly larger opening is done for total nephrectomy.
  • Robot-assisted laparoscopic surgery:  Robot assisted surgery wherein the robotic instruments are controlled by the surgeon via the operating interface, requires even smaller incisions and provides better quality imaging and facilitates precise and accurate removal.

Nephrectomy Complications:

The nephrectomy risks include:

  • Need of an open surgery.
  • Bleeding.
  • Fever.
  • Nausea.
  • Constipation.
  • Fatigue.
  • Urinary abnormalities.
  • Infection.
  • Lower body aches.
  • Organ/ Tissue Injury

Follow- up:

It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:

  • 24 to 48 hour surveillance.
    Visit doctor:
  • Removal of urinary catheter in one or two days of surgery.
  • Caring for your remaining kidney:
  • Have light healthy diet with limited salt intake
  • Avoid high protein diet, alcohol and caffeine
  • Avoid strenuous activity and exercise for several weeks.
  • Monitor urine protein levels and glomerular filtration rate.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Blood pressure

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.