What does the procedure involve?
This involves removal of the kidney, adrenal, surrounding fat and lymph nodes for suspected cancer of the kidney, using an incision either in the abdomen or in the side/flank.
What are the alternatives to this procedure?
Observation alone, partial nephrectomy and laparoscopic (telescopic or minimally-invasive) nephrectomy.
What should I expect before the procedure?
You will usually be admitted the day of your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the surgical team which will include the Consultant, Specialist Registrar, and your named nurse.
What happens during the procedure?
A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. The kidney is usually removed through an incision in your abdomen although, on occasions, the incision is made in the side (loin) or extended into the chest area. A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is sometimes placed through the skin to lie where the kidney was removed from.
What happens immediately after the procedure?
After the operation, you may remain in the Special Recovery area of the operating theatres before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will normally have a drip in your arm and, occasionally, a further drip into a larger vein in your neck.
You will be able to drink clear fluids immediately after your operation and start a light diet within 1-3 days. We will encourage you to mobilise as early as possible and to take fluids or food as soon as you are able. We would expect your hospital stay to be about 5-7 days but some people do go home sooner or may need to stay slightly longer.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
There is a small risk of bleeding with surgery, and you may require a blood transfusion. Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
It will be at least 14 days before healing of the skin wound occurs but it may take up to 3 months before you feel fully recovered from the surgery. You may return to work when you are comfortable enough and your GP is satisfied with your progress. It is advisable that you continue to wear your elasticated stockings for 14 days after you are discharged from hospital. Many patients have persistent twinges of discomfort in the loin wound which can go on for several months.
After surgery through the loin, the wall of the abdomen around the scar will bulge due to nerve damage. This is not a hernia but can be helped by strengthening up the muscles of the abdominal wall by exercises.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
It will be at least 14-21 days before the pathology results on your kidney are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
An outpatient appointment will be made for you 6 weeks after the operation when we will be able to inform you of the pathology results and give you a plan for follow-up.
Once the results have been discussed, it may be necessary for further treatment but this will be discussed with you by your Consultant or Specialist Nurse. After removal of one kidney, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.
