Nephrectomy, Simple or Partial (Removal of Part or All of the Kidney)

What is a simple or partial nephrectomy?

A simple nephrectomy is surgery to remove the kidney. A partial nephrectomy is removal of part of a kidney.

When is it used?

The reasons for removing all or part of a kidney include:

• You may have cancer in your kidney.
• You may have large stones in your kidney.
• Your kidney may be damaged and very small, causing high blood pressure.
• You may have an infection that antibiotic treatment cannot cure.

An alternative to this procedure is to choose not to have treatment, recognizing the risks of your condition. You should ask your healthcare provider about this choice.

How do I prepare for this procedure?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Avoid medicines that may contain aspirin, such as nonprescription cold medicines. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. It will relax your muscles and cause a deep sleep. It will prevent you from feeling pain during the operation.

The surgeon makes a cut (incision) in your side and lower back, or in the front of your abdomen. The surgeon separates the kidney from the organs around it.

In a simple open nephrectomy the surgeon separates the kidney from the vein, artery, ureter (the tube that runs from the kidney to the bladder), and the fat tissue around it, and removes the kidney. The surgeon then ties off the vein, artery, and ureter. If cancer is strongly suspected, then a radical nephrectomy is performed. This means surrounding tissue (fat and lymph nodes), the adrenal gland, and the ureter are also removed.

An alternative to open nephrectomy is robotic laparoscopic nephrectomy. Robotic surgery is done in a way similar to open surgical removal of the kidney. The difference is that instead of a large cut made in the front or side of the abdomen, only 4 to 6 small cuts, each less than an inch long, are needed. Your surgeon’s tools can pass through these small cuts to do the surgery, keeping his or her hands outside your body. All or just a part of the kidney may be removed, depending on the situation.

Another alternative is removal of just part of the kidney. This procedure is called a partial nephrectomy and is done in ways similar to removal of all of the kidney. It may be done when a kidney tumor is small enough to allow part of the kidney to be saved.

When partial kidney removal is planned, with either the laparoscope or open surgery, it is possible that the findings at surgery will require removal of all of the kidney. Talk to your healthcare provider about this.

What happens after the procedure?

You may be in the hospital for about 4 to 7 days. A catheter (tube) stays in your bladder for a few days to allow urine to drain and to relieve the pressure. The catheter will be removed before you go home. You may have a drain through the skin in the area of the surgery. It is usually removed in 1 to 2 days, before you go home.

During the first 2 weeks after the operation, you will be encouraged to do light activity, such as walking. Avoid all heavy activity for the first 6 weeks, including lifting. After that time, you may gradually do heavier work according to your provider's instructions.

Ask your healthcare provider about what medicines you can take for pain and how to care for yourself during your recovery. Removing all or part of a kidney may affect your kidney function enough to cause problems when you take medicines. Ask your provider for a list of medicines that you should avoid. For example, you may need to avoid medicines that contain acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen.

Ask when you should come back for a checkup.

What are the benefits of this procedure?

The kidney and its contents, such as stones, cancer, or infection, will be removed. If you have cancer, the cancer may be cured.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• You may have infection or bleeding.
• Your spleen, adrenal gland, or pancreas may be injured during the operation.
• The nerves in the area of the incision may be damaged either by pressure or by being cut. This could cause problems with the muscles in your lower back. It could also cause the side of your abdomen to sag. You could lose the feeling in the area around the incision. This could be a temporary or permanent condition.
• If you had cancer, not all of it may have been removed, and the cancer may grow back.
• Your kidney function will be tested before surgery. If your remaining kidney is weak, your healthcare provider will discuss this special risk with you before surgery. You may need dialysis. Dialysis is a mechanical way to do the work your kidneys normally do.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (37.8°C).
• You become nauseated or start vomiting.
• You have a lot of pain.
• You become unusually weak.
• The wound is leaking or bleeding.
• You get short of breath.
• You have trouble passing urine.

Call during office hours if:

• You have questions about the procedure or its result.
• You begin to have swelling in your legs and ankles.
• You want to make another appointment.