Nephroureterectomy

Overview

A nephroureterectomy (pronounced neff-roh-yer-it-ter-eck-toh-mee) is a surgical procedure that involves removing the renal pelvis, kidney, entire ureter, and a portion of the bladder known as the bladder cuff. The renal pelvis is a funnel-shaped structure located in the center of each kidney that collects urine and directs it into the ureters. The ureters are muscular tubes that transport urine from the kidneys to the bladder, where it is stored. The bladder cuff is a small segment of tissue where the ureter connects to the bladder.

This surgery may be recommended by your healthcare provider if you have transitional cell cancer, also called urothelial cancer. A nephroureterectomy is considered a radical surgery, which means it involves removing not only the tumor but also any nearby organs that the cancer may have invaded. For instance, if the cancer has spread to the colon, a portion of the colon may also be removed along with the kidney and ureter.

In a traditional open nephroureterectomy, your healthcare provider makes one or two large incisions in your abdomen, sometimes removing a rib. The first incision can range from 8 to 12 inches long. This approach is typically used for large and invasive tumors.

Nowadays, most nephroureterectomy procedures are performed using robotic-assisted laparoscopic techniques. This advanced technology allows healthcare providers to make precise movements in hard-to-reach areas of the body, offering a less invasive option with potentially quicker recovery times.

Reasons for undergoing the procedure

A nephroureterectomy is the standard treatment for transitional cell cancer of the ureter or renal pelvis, particularly in cases of aggressive cancer. It’s essential to understand your treatment options as a first step in managing cancer.

Laparoscopic radical nephroureterectomy is a procedure used to treat transitional cell cancer in the upper urinary tract, which includes the kidneys, ureters, bladder, and urethra. The transitional epithelium is the lining tissue of these organs, and this procedure targets cancer affecting this specific tissue.

Risks

There are dangers associated with every surgical treatment. Among the dangers of a nephroureterectomy are:

• Risks associated with anesthesia.
• Healing issues.
• Potential requirement for hemodialysis.
• Infection
• Hematatoma, or mass of clotted blood.
• Clots of blood.
• Seroma, or fluid accumulation at surgical sites.

Before the procedure

Before undergoing a nephroureterectomy, you will have a pre-operative appointment with your doctor to assess your overall health. During this visit, your vital signs (temperature, pulse, and blood pressure) will be checked.

It’s crucial to inform your healthcare provider about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and herbal supplements. Some medications, such as aspirin, anti-inflammatory drugs, and certain herbal supplements, can increase the risk of bleeding. Always consult your doctor before stopping any medications.

Additionally, let your doctor know about any allergies you have, including those to medications, skin cleaners like iodine or isopropyl alcohol, latex, and foods.

Your doctor will give you specific instructions about eating and drinking before your surgery. You’ll need to follow a clear liquid diet for 24 hours prior to the procedure and avoid eating anything after midnight the night before. If you need to take medications, use only a small sip of water.

During the procedure

A nephroureterectomy will be carried out by a unique team of medical professionals. Nurses, anesthesiologists, and urologists usually make up the team.

• General anesthesia will be used by your anesthesiologist to put you to sleep. Throughout the process, you won’t feel any pain, move, or be awake.
• When you’re unconscious, your urologist will gently make numerous tiny incisions in your abdomen using a sharp, sterilized knife (scalpel). After that, they will make incisions and implant a strong laparoscope to inspect the affected portions of your body.
• Your urologist will make an incision and remove your afflicted organs using tiny, specialized surgical equipment.
• Ultimately, your urologist will sew your incisions shut with stitches. Your incision sites may be filled with tiny silicone tubes, sometimes known as drainage tubes. Drainage tubes are used to remove fluid or blood. The tubes will be sewn into place.

The average length of a laparoscopic nephroureterectomy is two to four hours.

After the procedure

After a nephroureterectomy, your doctor will cover your stitches with bandages. Your anesthesiologist will stop administering anesthesia, allowing you to wake up. You’ll be moved to a recovery room where medical staff will monitor your health and ensure you fully regain consciousness. They will also manage any pain you may experience.

Anesthesia can sometimes cause nausea, but medication is available to help relieve it. For the first one to two days after surgery, you’ll follow a liquid diet to aid in your recovery. Your doctor will gradually reintroduce solid foods as you progress.

The day after surgery, healthcare providers will assist you in getting out of bed and walking. This is important for your recovery, as walking helps prevent blood clots in your legs and reduces the risk of pneumonia.

Once your doctor determines that you are stable and no longer need close monitoring, you will be discharged and allowed to go home. A family member or friend must drive you home, and it’s advisable to have someone assist you for a few days after the procedure.

Outcome

A nephroureterectomy requires approximately six weeks of rest and relaxation. After surgery, you should wait at least two weeks before driving and avoid physically demanding activities, such as running or lifting objects heavier than 20 pounds. Engaging in intense physical activity can lead to hernias, damage, or pressure on your stitches. Walking is encouraged and considered a safe form of exercise during your recovery.

Recovery times vary from person to person. As you heal, it’s important to understand your body’s limits and follow the advice given by your healthcare provider for managing pain and discomfort.

Typically, you can resume your job within four weeks or less after the surgery. If your job involves minimal physical exertion, you might be able to return to work sooner. However, if your job requires significant physical effort, you might need to plan for additional time off.