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What is Nephrectomy?
This procedure is often done when a cancerous kidney needs to be removed or if one or both of these bean-shaped organs has been severely damaged by disease. In some cases, it may be possible to save part of the kidney with what's referred to as kidney-sparing surgery.
A partial nephrectomy is the removal of kidney tissues without the complete removal of the organ. A urological surgeon may suggest this procedure for patients with small tumors limited to one part of a kidney, non-cancerous (benign) tumors, or problems related to kidney stones that aren't treatable with other options. The procedure may also be recommended for patients exhibiting signs of kidney failure not yet at the point where full removal is necessary. The main benefit for patients is that a significant portion of kidney can be left intact.
Radical (complete) nephrectomy
During a radical nephrectomy, the urologic surgeon removes the entire kidney and often some additional structures, such as part of the tube that connects the kidney to the bladder (ureter), or other adjacent structures such as the adrenal gland or lymph nodes.
Why it needs to be done?
Mainly, it is done toremove a tumor from the kidney. These tumors are usually cancerous, but they can be noncancerous (benign). Sometimes a nephrectomy is needed because of other kidney diseases.
How does kidney functions for our body?
Filter wastes and excess fluid and electrolytes from your blood
Maintain proper levels of minerals in your bloodstream
Produce hormones that help regulate your blood pressure and that influence the number of circulating red blood cells
The urologic surgeon makes a decision based on the results of imaging tests, which may include:
Computerized tomography (CT), a specialized X-ray technology that produces images of thin cross-sectional views of soft tissues
Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to produce cross-sectional views or 3-D images
Ultrasound, an image of soft tissues produced with the use of sound waves
Ways of Nephrectomy
This is generally performed with smaller incisions and special instruments, a laparoscopic nephrectomy is less-invasive way to remove all or part of a kidney. The procedure is performed with a thin, lighted tube attached to a camera (laparoscope) through small abdominal incisions. During the operation, the urologic surgeon has a real-time view of the affected area on a monitor. Because incisions are smaller, there's less risk of infection and recovery times are often shorter.
Robot-assisted kidney removal is performed with a special surgical system. The doctor is seated in a unit with a control panel while a robotic arm completes the procedure. All movements mimic the surgeon's hand motions. The 3D images displayed to the surgeon are highly detailed. The robotic arm is also supervised by another doctor who sits directly by the patient. The advantage for patients is increased precision with surgical movements and less risk of damage to nearby tissues and nerves as the kidney is removed.
The removal of a single kidney does not mean a transplant is necessary since it's possible to live a healthy, productive life with a single kidney. If a kidney is removed because of cancer, a urologist may recommend periodic screenings as a preventative measure. If a transplant is done following a nephrectomy, immune suppressant medications will need to be taken to reduce the risk of rejection. Post-removal care for all patients typically involves regular urinary system exams. Patients are also encouraged to maintain a healthy lifestyle that includes regular exercise and nutrient-rich foods.
Risks involved in Nephrectomy
Nephrectomy is generally a safe procedure. However some potential risks are:
Injury to nearby organs
Rarely, other serious problems
Problems that may occur with long-term reduced kidney function include:
High blood pressure (hypertension)
Chronic kidney disease
Potential risks and complications depend on the type of surgery, reasons for surgery, patient's overall health and many other issues, including surgical expertise and experience. These procedures are performed by urologists with advanced training and extensive experience to minimize the chances of problems related to surgery and assure the best possible outcomes.
Preparation of surgery
Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your doctor if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)
Bowel preparation and clear liquid diet
Drink one bottle of magnesium citrate, which you can purchase at your local pharmacy, the evening before your surgery. Do not eat or drink anything after midnight. Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through.
Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.
Clear broths (no cream soups, meat, noodles, etc.)
Juices (no orange juice or tomato juice)
Apple juice or apple cider
Tea (you may add sweetener but no cream or milk)
Coffee (you may add sweetener but no cream or milk)
Clear Jell-O (without fruit)
Popsicles (without fruit or cream)
Italian ices or snowballs (not marshmallow)
During the procedure
A nephrectomy procedure is performed during general anesthesia. You'll receive a medication (anesthetic) before surgery so that you won't be awake or feel pain during surgery. You'll also have a urinary catheter — a small tube that drains urine from your bladder — placed before surgery. During the procedure, the urologic surgeon and anesthesia team work together to minimize pain after surgery.
Procedure varies, depending on how the surgery is performed and how much of the kidney is removed. Variations include:
Laparoscopic surgery. In this minimally invasive procedure, the surgeon makes a few small incisions in your abdomen to insert wandlike devices equipped with video cameras and small surgical tools. The surgeon must make a slightly larger opening if your entire kidney needs to be removed.
Robot-assisted laparoscopic surgery. In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon's hand can do in open surgery.
Open surgery. In an open nephrectomy, the urologic surgeon makes a cut (incision) along your side or on your abdomen. This open approach allows surgeons to perform some surgeries that still can't be performed safely with less invasive approaches.
Radical nephrectomy. In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland. In some cases lymph nodes or other tissues are removed as well.
Partial nephrectomy. In a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible.
Your urologic surgeon will discuss the advantages and disadvantages of robotic or other types of minimally invasive surgery versus open surgery, including issues such as scarring and the time it takes to return to normal activities.
After the procedure
Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of nephrectomy performed. The urinary catheter remains in place for a short time during your recovery. Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you'll need to avoid strenuous activity or heavy lifting for several weeks. For most patients, these procedures don't affect quality of life — once you're completely recovered, you can expect to resume your normal routine and activities.
Monitoring kidney function
Most people can function well with only one kidney or with one whole kidney and part of the second. You'll likely have checkups to monitor the following factors related to kidney function.
Blood pressure. You'll need careful monitoring of your blood pressure because decreased kidney function can increase blood pressure — and high blood pressure can, in turn, damage your kidney.
Protein urine levels. High protein urine levels (proteinuria) may indicate kidney damage and poor kidney function.
Waste filtration. Glomerular filtration rate is a measure of how efficiently your kidney filters waste. The test is usually performed with a sample of blood to measure the creatinine level. A reduced filtration rate indicates decreased kidney function.
Taking care of your remaining kidney
After a nephrectomy or partial nephrectomy, you may have overall normal kidney function. To preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity and attend regular checkups to monitor your kidney health.
If you develop chronic kidney disease (reduced kidney function) after complete or partial nephrectomy, your doctor may recommend additional lifestyle changes, including possible dietary changes and being careful about prescription and over-the-counter medications.
Frequently asked questions
What is the recovery time for kidney removal?
It takes around 3 to 6 weeks. You may have some of these symptoms: Pain in your belly or on the side where you had the kidney removed. The pain should get better over several days to a week.
How serious is a nephrectomy?
Nephrectomy is generally a safe procedure. But as with any surgery, itcarries a potential risk of complications, such as: Bleeding, Infection.
Can I live a normal life with one kidney?
There may also be a chance of having high blood pressure later in life. However, the loss in kidney function is usually very mild, and life span is normal. Most people with one kidney live healthy, normal lives with few problems. In other words, one healthy kidney can work as well as two.
Does remaining kidney grow after Nephrectomy?
Unrestrained hypoxia inducible factor activation in renal cancer promotes growth and may play an important role in driving CRH. Compensatory hypertrophy of the remaining kidney starts within hours following nephrectomy, until it reaches a functional capacity of approximately 80% of two functioning kidneys.
Can you drink alcohol if you only have one kidney?
The risk of kidney damage is even higher for heavy drinkers who also smoke. Alcohol has this effect whether you have one or two kidneys, but it may lead to kidney failure more quickly when you only have one functioning kidney.
What happens to GFR after nephrectomy?
Compared to the normal age-related decline in GFR, the rate of decline in patients with renal disease is accelerated. Nephrectomy is associated with an acute and significant drop in the GFR, due to the immediate loss of renal mass.
Which Drugs are Harmful to Your Kidneys?
Pain Medications. Your kidneys could be damaged if you take large amounts of over-the-counter medications, such as aspirin, naproxen and ibuprofen.
Contrast Dye (used in some diagnostic tests such as MRIs).
What is the first sign of kidney problems?
Signs and symptoms of acute kidney failure may include: Decreased urine output, although occasionally urine output remains normal. Fluid retention, causing swelling in your legs, ankles or feet, shortness of breath.
What foods help repair kidneys?
Red bell peppers (1/2 cup serving red bell pepper = 1 mg sodium, 88 mg potassium, 10 mg phosphorus).
Cabbage (1/2 cup serving green cabbage = 6 mg sodium, 60 mg potassium, 9 mg phosphorus).
What Will the Recovery Be Like?
Most patients are able to return to full activity within 4-6 weeks compared with 8-12 weeks for open partial nephrectomy.
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