The kidney is a paired organ in the upper abdomen that filters the blood of waste then excretes this filtered waste in the form of urine. The urine is transported from the kidney via the ureter to the bladder in the pelvis where it is stored.

When a high grade or large tumour develops on the internal lining of the kidney or ureter then a Laparoscopic Nephro-ureterectomy is required to remove the entire kidney and ureter. If the tumour is in one section of the ureter only then a robotic segmental ureterectomy can be performed in selected circumstances so that the kidney can be spared (this operation is described in a separate information sheet).

Pre operation

Ten days prior to the procedure you should:

  • Have your blood and urine test
  • Notify Mr Thyer’s rooms if you are taking any blood thinning medication
The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 3 hours. Mr Thyer will make a series of 4 small incisions in the abdomen to allow the passage of the laparoscopic instruments. The kidney and ureter will be dissected free from its surrounding structures and the blood vessels to the kidney clipped and divided. The kidney and ureter as well as a cuff of bladder at the distal end of the ureter will be removed via a small incision in the lower abdomen and sent to a pathologist for microscopic examination (you may incur a pathologist fee). The defect in the bladder will be closed with sutures and a catheter will be placed in the bladder to remain for 10 days. After the operation a drain will be left in the abdomen. Most people are in hospital 2 nights then discharged home after Mr Thyer’s review.

Nephro-uretectomy: open surgical incision vs laparoscopic incision

Nephro-uretectomy: open surgical incision vs laparoscopic incision

Risks
  • Bleeding. Bleeding from the operation site is very rare but if occurs may necessitate a return to theatre.
  • Infection. Wound infection is rare but may require a course of oral antibiotics to correct. Bladder infection is quite common as a catheter remains in the bladder for 2 weeks.
  • Conversion to open nephrectomy. Occasionally a kidney is more difficult to dissect free than anticipated using the laparoscopic technique and conversion to open approach is required.
  • Injury to surrounding structures. The bowel, liver, spleen, adrenal, pancreas, gynaecologic organs and large blood vessels are close to the kidney and ureter and may require repair if injured during the dissection.
  • Urine leak. Occasionally the urine can leak between the sutures placed to close the defect in the bladder. Prolonged catheterisation for an extra few weeks will almost always correct this issue.
  • Chronic renal impairment. Most people have no trouble living with one kidney but occasionally the remaining kidney can struggle to function adequately and input from a renal physician may be required.
  • Hernia. Very occasionally (1%) a hernia can develop at the kidney extraction site which requires correction with a general surgeon.
  • Recurrence of cancer. 50% of people undergoing this operation go on to develop cancer recurrence in the bladder. Mr Thyer will check your bladder every 6 months to ensure this is detected quickly and treated.
  • There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.
Follow up

You will require a CT cystogram at 2 weeks to ensure the bladder has healed. If the CT is satisfactory then the catheter can be removed from the bladder usually the same day. Mr Thyer’s rooms will contact you to arrange follow up to check your progress, wounds and pathology 3 weeks following the operation. You should take laxatives, wear compression stockings, drink plenty of water and avoid heavy lifting for 3 weeks following the procedure. You should not drive a motor vehicle until seen by Mr Thyer at the follow up appointment. Mr Thyer will perform flexible cystoscopy every 6 months to ensure there is no recurrence of cancer in the bladder.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

  • Have a fever over 38 Degrees
  • Feel the catheter is not draining urine
  • Have not received a follow up appointment
  • You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000.

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