Dr Jo Schoeman
Urological Surgeon

        

Radical Nephro-ureterectomy

Product Summary: AMA rate The affected kidney with ureter and a cuff bladder is removed

Item Number: 36532, 105, 36533, 105

For urothelial cancers contained in the kidney / ureter. This is a intended curative procedure, depending on staging. It involves removing the complete reno-ureteric unit with a cuff of bladder.

It can be done open or laparoscopically.

Why is it done?

  • Finding of 1 or more solid lesions inside the collecting systems of the kidney or ureter (intraluminal).
  • Usually presents with macroscopic hematuria and flank pain.
  • Usually a Urothelial Carcinoma (previous Transitional Cell Carcinoma TCC).
  • Potentially curative process if staging is negative ie. No spread of tumour.
  • Staging with CT abdomen and chest Bonescan MRI if in Renal Failure o Contrast Allergy.
  • Could also be done in metastatic disease with uncontrollable haemorrhaging.

How is it done?

  • Patients will receive a general anaesthesia.
  • Prophylactic anti-biotics is given.
  • The correct kidney is identified and marked while you are awake.
  • A cystoscopy will be done first with a loosening of ureter inside the bladder and tied off of the ureter in order that there will be no spilling of ureteric content in the abdomen.
  • Depending on the side of the tumour 3-4 incisions will be made: 1 for the hand-port of approximately 8cm depending on the amount of sub-cutaneous fat present 1 for the camera-port 1 for the working-port (1 for the liver retractor on the right).
  • The colon is reflected to reveal the retro-peritoneal space.
  • The ureter is identified and cleared up to the hilum.
  • The arteries are identified and marked with vessel loops More than 1 can be present. Confirmed with CT arteriography.
  • Then the vein/ viens are identified and marked with a vessel loop.
  • The rest of the kidney is mobilized and loosened.
  • Then the ureter is mobilized all the way down into the pelvis and plucked from the bladder where it has been loosened.
  • Drain are left post-operatively.
  • A catheter will be left for minimum of 5 days.

What next?

  • You will spend up to 5 nights in hospital.
  • You will have a catheter for that time.
  • A drain for 2-3 days.
  • You will a trial without the catheter on the 5th day.
  • Renal functions will be checked daily.
  • You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
  • You will be discharged as soon as your renal function has stabilised and you can function independently.
  • Allow for 6 weeks for stabilization of symptoms.
  • Restrict fluid intake to less than 3 L per day.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

  • Blood loss 20-500cc.
  • May convert from a laparoscopic to open procedure.
  • Wound Infection.
  • Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
  • NB! Each person is unique and for this reason symptoms vary!

Very Important!!

The correct side for surgery should be checked:

  • CT scan present.
  • Your approval.
  • Prior to anaesthesia being commenced.

Radical Nephro-Ureterectomy Radical Nephro-Ureterectomy (301 KB)