Radical nephrectomy may also be required to remove kidneys severely damaged by obstruction, stones or infection. It can be performed through open, laparoscopic or robotic approaches.
Before Your Surgery
Certain medications increase the risk of bleeding and need to be stopped prior to surgery. You should tell your surgeon about all prescription medicines, over the counter medicines, vitamins, and herbal supplements that you are taking. Some patients, such as those with artificial heart valves or high blood clotting risk, will need to take blood-thinning injections whilst coming off their tablet medications.
After Your Surgery
When you wake from anaesthesia you will have a catheter draining the bladder and a drain tube in your abdomen. You will have dressings over the incisions in your abdomen, and a drip in your arm. The drain tube, drip and catheter are usually removed within one to two days.
You should expect some discomfort in the area of your incisions. Whilst in hospital you will receive regular oral and intravenous painkillers. You will continue to take tablet painkillers once you go home. While you are taking painkillers you should also take stool softeners (eg. coloxyl and senna) to prevent constipation.
You will be expected to get out of bed on the day after your surgery and start walking. This will help minimize the risk of blood clots in the legs. You should aim to go for a walk every two hours.
After a laparoscopic or robotic procedure most patients should be able to go home the following day or the day after that. Patients who have an open operation usually require two to three nights in hospital.
The dressings on your wounds can stay in place until your review appointment. If the dressings fall off and the wounds are clean and dry there is no need to replace them. Steri-Strips (adhesive tape) on your incisions can be removed after 7 days. You may shower any time once you are home, but you must not take a bath until the catheter is removed.
Continue to take painkillers as required. If you need to take strong painkillers containing codeine, remember to also take stool softeners to avoid constipation.
Resuming Normal Activities
No driving for a minimum of 2 weeks after the operation. Avoid heavy lifting, bending, stretching, or straining activities like mowing the lawn for up to 4 weeks after your surgery. You may resume walking or light exercise immediately after your procedure. Ask your surgeon when to recommence blood-thinning medications. You will probably be able to return to work 2 weeks after your surgery. Depending on your occupation, light duties may be required for the first few weeks.
Specific Risks and Side Effects
- Patients normally experience some discomfort for a few weeks after a nephrectomy. Sometimes the pain is more severe and prolonged due to entrapment or scarring surrounding nerves within the wound. This rarely requires further procedures to improve symptoms.
- Skin numbness may occur around the area of the wound due to the need to cut nerves supplying the skin. Over time the area of numbness usually reduces but may never return to normal sensation.
- Wound infection is uncommon and can usually treated with antibiotics alone. Surgical drainage is rarely required for a more serious infection.
- Heavy bleeding is uncommon. Less than 10% of patients require a blood transfusion.
- Ileus refers to the phenomenon of delayed return of bowel function after surgery. If a patient develops ileus, he or she will need to stay in hospital on intravenous fluids until bowel function returns.
- A hernia is a defect in the abdominal wall that can occur at a surgical incision site. Some hernias require surgical repair due to the risk of bowel becoming entrapped within them.
- Rarely at the time of the operation it may become obvious that the kidney cannot or should not be removed due to the extensive nature of the cancer or widespread cancer within the abdomen. In this case the procedure will need to be abandoned.
- If you have pre-existing problems with kidney function, then there is a risk that removal of one kidney can result in worsening kidney function over time and even potentially the need for dialysis (machine filtering of the blood to duplicate normal kidney function).
- The kidneys are located adjacent to the lungs and there is a risk of breathing difficulties after surgery due to a chest infection or a collapsed lung (pneumothorax) which may require treatment with insertion of a chest drain tube.
- If nephrectomy is being performed for a kidney cancer there is a risk that cancer can recur, either in the vicinity of the removed kidney, the other kidney or elsewhere in the body. The risk of recurrent disease relates to the extent and aggressiveness of the original tumour.
- Damage to other organs may occur, including:
- Spleen: Very rarely injured during left-sided surgery. If injury occurs, in 5% of cases the spleen may need to be removed. Patients who have had their spleen removed require vaccinations and possibly long-term antibiotics.
- Intestine: Damage is uncommon and is usually identified and repaired at the time of surgery with no long-term consequences
- Pancreas: Rarely injured in a left-sided operation
- Liver: Rarely injured in a right-sided operation
- Anaesthetic complications, such as heart attack or stroke.
- Infection, for example of the urinary tract, chest, or other sites.
- Clots forming in the legs (DVT), which may then pass to the lungs.
- Allergic reactions to drugs, antiseptics, or wound dressings.
- The risk of death relates to the patient’s general health and the complexity of the surgery, and may arise due to either anaesthetic or surgical complications.
When to contact your surgeon
- If you experience fevers, sweats, shakes, nausea or vomiting after you go home, or if you feel generally unwell.
- If you have pain that is not relieved by regular pain killers.
- If you notice any increase in redness or swelling around your wounds.
- If you are unable to open your bowels.
- If you are unable to pass urine.