What is a radical nephrectomy?

A radical nephrectomy is a procedure to remove cancer in and around one of your kidneys. The doctor removes the kidney, ureter (the tube connecting the kidney to the bladder), and surrounding connective tissue, lymph nodes, and adrenal gland.

When is it used?

This procedure is done to remove cancer in your kidney and/or ureter.

Examples of alternatives are:

• having only your kidney removed

• having only your kidney and/or ureter removed

• having radiation or chemotherapy

• choosing not to have treatment while recognizing the risks of your condition.

You should ask your doctor about these choices.

How do I prepare for a radical nephrectomy?

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

For 1 week before your surgery, do not take aspirin, ibuprofen (such as Motrin or Advil), or any other nonprescription pain relievers except for acetaminophen (such as Tylenol). You may take acetaminophen for pain.

Follow any instructions your doctor may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

A general anesthetic is given. It will relax your muscles and make you feel as if you are in a deep sleep. It will prevent you from feeling pain during the operation.

The doctor makes a cut either in the front or on the side of your abdomen. For some large tumors, the cut may be made in the lower part of the chest. The doctor separates the kidney from surrounding organs and locates its main artery and vein, as well as the ureter. Then the doctor removes the kidney and the tumor and ties off the vein, artery, and ureter. The doctor also removes surrounding tissue and the adrenal gland and lymph nodes.

The doctor may also make the cut longer or make a second cut over your bladder to remove the ureter. The ureter is removed from the bladder and the doctor closes the cut.

What happens after the procedure?

You may stay in the hospital for about 4 to 7 days. A catheter (tube) remains in your bladder for about a week to allow urine to drain and relieve the pressure. You may have a tube in your chest for 1 to 4 days.

During the first 2 weeks after the operation, you may do some light exercise, such as walking, but avoid all heavy activity for the next 4 weeks. During the following 6 to 8 weeks you may gradually do heavier work.

Ask your doctor what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You may no longer have cancer.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• The pancreas may be injured during this operation.

• The nerves around your kidney may be damaged either by pressure or by being cut. This could cause problems with the movement of the muscles in your lower back and cause the side of your abdomen to sag. You could (temporarily or permanently) lose some or all of the feeling in your lower back.

• Rarely, the vein and artery connected to your kidney may form a connection between themselves and allow blood to flow from one to the other. If this happens you may need another operation to have them separated.

• Urine may leak from the cut made in the bladder.

• The doctor may not be able to remove all of the cancer or the cancer may come back.

• There is a risk of infection and/or bleeding.

• Your remaining kidney may not be able to function enough to clear the waste products from your system. You may need dialysis, a technique that separates wastes from your bloodstream.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.

• You become nauseated or start vomiting.

• You have uncontrollable pain.

• You become short of breath.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You begin to have swelling in your legs and ankles.

• You want to make another appointment.