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Removal of whole or part of the kidney

What does this procedure entail?

This involves the removal of a part of the kidney (including the surrounding tissue and fat) in cases with suspected cancer (exceptionally in other reasons).

What are the alternatives to this procedure?

  • Laparoscopic or robotic surgery;
  • Removal of the whole kidney with the tumour (in certain indications);
  • Radiofrequency ablation of the tumour – usually in cases associated with high surgical risks;
  • Observation – monitoring; only if the tumour is not probable to affect the patient's survival or the patient's medical condition does not allow for any other therapy;
  • System chemotherapy, biological treatment – in case of generalisation and metastasis (spread to distant parts of the body by blood)

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

  • artificial heart valve
  • coronary artery stent  pacemaker
  • artificial joint
  • artificial vascular graft
  • neurosurgical bypass
  • other implanted foreign body
  • use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
  • drug and other allergies
  • any abnormalities or eventualities.

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first. The procedure is performed exclusively under general anaesthesia.

The surgery is started by an incision in the lumbar region above the navel. The kidney is released, the surrounding vessels and ureter are visualised and a part of the kidney with the tumour is removed. This area is sutured (and/or treated with tissue glue). A urinary catheter is inserted into the bladder before the surgery (it is used to collect urine). A drain is inserted into the kidney bed through the skin (it removes blood and tissue secretion from the original kidney location). A stent (a tube between the kidney and the bladder) is sometimes inserted into the kidney to ensure better drainage of the urinary tract and facilitate healing. It will only be removed after the wound is healed (usually in 6-8 weeks in an outpatient manner).

A gastric tube (usually through the nose) is exceptionally introduced to prevent stomach and bowel dilation due to the presence of gases.

This procedure takes between 90-150 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

Patients usually have an infusion access point into a vein in their arm; if necessary, a monitoring/infusion port (a tube inserted into the vein to monitor blood pressure or administer drugs and nutrition) will be inserted into a vein (jugular vein) in the superclavicular region (the area between the collarbone and neck).

Nutrition is provided in an intravenous manner shortly after the surgery. You will receive a liquid and mushy diet for the next 2 to 3 days. This procedure is necessary for the proper restoration of gastrointestinal function. Non-compliance of the patient is usually associated with severe abdominal pain, vomiting with the risk of suffocation and may require surgical revision (further surgery in case of complications).

Physical rehabilitation is very important to prevent complications in the postoperative period. You will first exercise on the bed. As soon as your medical condition allows, you will be allowed to sit down and then stand up. After that, you will be able to walk slowly and carefully around the room, initially accompanied by medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.

The drainage from the wound will be removed according to the amount of fluid/urine, usually on the day 5 after the surgery. Exceptionally, it can also be left in your body when you stay at home (even the bladder catheter) to facilitate the complete healing of the kidney. Sutures will be removed before you are discharged from the hospital. The average hospitalisation is 9-10 days.

Once you are fully conscious, you should:

  • ask if the planned outcome was achieved
  • inform the medical staff about any problems
  • ask what you can and cannot do
  • ask all the questions you have for the healthcare professionals and members of the medical team
  • remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

Temporary insertion of bladder catheter and drain Urethral fistula in the wound requiring the insertion of a stent, possibly further treatment Bulging at the incision site due to damage to the nerves of the abdominal wall (interruption of muscle innervation when approaching the kidney)

Occasional (2-10% of procedures of this type)

Bleeding requiring further surgery or transfusion Removal of the whole kidney, if partial removal is not possible Lung injury requiring temporary removal of gas from the chest cavity Need for further cancer treatment after the surgery Infections, pain or swelling at the incision site requiring further treatment

Rare (may occur in 2% of procedures of this type)

Cardiovascular or anaesthesia-related complications that may require a longer stay at the intensive care unit (lung infections, pulmonary embolism, heart attack, deep vein thrombosis, etc.) Injuries to nearby surrounding structures (blood vessels, spleen, liver, lungs, pancreas and intestines) requiring more extensive surgery or planned revision.

Negative histological finding - the removed tumour was not malignant. The need for further treatment if histological results show that the tumour was not removed in its entirety.

Hospital infections

  • MRSA colonisation (0.9% – 1 of 110)
  • Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
  • MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

  • get recommendations on recovery at home
  • ask when you can return to normal activities such as work, exercise, driving, housework
  • get a contact number for further questions after returning home or in case of trouble
  • ask about the date of the following check-ups and the place where you should come (hospital or your attending physician)
  • make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs.
  • At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

What else should I watch out for?

It is recommended that you wear elastic stockings for 2-3 weeks after the discharge from the hospital.

Uncomplicated skin incisions will heal in about 14 days. After that, you will be able to take a regular shower. The healing of internal structures takes 6 to 12 weeks, so it is necessary to maintain a resting regime even after discharge from the hospital. It usually takes 8-16 weeks until you are able to return to work. Talk about this with the doctor who treated you in the hospital, or at least with your general practitioner.

If you have a stent in your kidney, you may urinate more often and you may experience discomfort and mild pain in the bladder and sometimes at the tip of your penis, especially at the end of urination – sometimes bloody urine may appear.

The stent is usually removed 6-8 weeks after surgery.

Many patients complain about persistent episodes of pain (pulling, pressure, pulsing) in the lumbar region, which can last for several months. If the kidney access incision is in the lumbar region, the wound may arch due to the interruption of the nerves supplying the muscles of the abdominal cavity – it is not a hernia. This condition can be improved by strengthening the muscles of the abdominal wall with exercise (only after full healing!).

Important information?

In case of fever, redness, pulsation or secretion at the site of the surgical wound, contact your attending physician. Inform your attending physician of any other problems related to the procedure, do not underestimate any breathing difficulties. Bulging in the area of the wound in the lumbar region due to interruption of the nerves supplying the abdominal muscles is not a reason for acute examination.

The results of the histological examination are usually available within 2-3 weeks after the surgery. These findings may be decisive for your further treatment or follow-up. The date and place of your postoperative check-up will be determined at discharge based on the course of the surgery and postoperative care (usually 6-8 weeks after the surgery).

It is usually necessary to undergo further follow-up at the outpatient urology or oncology office.

 

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