A nephrectomy is a surgical procedure to remove part or all of a kidney. Depending on the reason it is required, a nephrectomy involves removing only the damaged or diseased part of one kidney; all of one kidney; or the entire kidney, along with the surrounding adrenal gland and lymph nodes. All nephrectomies are performed under general anesthesia.
The kidneys are located at the back of the abdomen, and protected by the lower ribs. Their function is to filter blood, which passes through them several times a day. The kidneys remove waste, control fluid balance, and regulate the balance of electrolytes. As the kidneys filter blood, they create urine, which is then excreted through the urinary tract. Because there are two kidneys, and each kidney cell (nephron) is a microscopic filter, a patient can function well after a partial or complete nephrectomy.
Reasons for Nephrectomy
A nephrectomy may be necessary to treat the following:
- Congenital defect
- Kidney damage (from kidney stones or disease)
- Kidney cancer
- Traumatic injury
- Kidney donation
Extremely high blood pressure and its effects can also make a nephrectomy necessary.
Types of Nephrectomy
There are three types of nephrectomy.
Partial Nephrectomy
During a partial nephrectomy, only the damaged or diseased part of the kidney is removed. It is frequently performed to treat kidney cancer.
Simple Nephrectomy
A simple nephrectomy involves the removal of an entire kidney. It may be performed to remove a diseased or severely injured kidney, or to remove a kidney for donation.
Radical Nephrectomy
With a radical nephrectomy, the entire kidney, the surrounding lymph nodes, and the adjacent adrenal gland are removed. It may be performed when malignant tissue has spread from the kidney to surrounding tissue.
Nephrectomy Procedure
A nephrectomy can be performed in one of two ways.A bladder biopsy may also be performed so that the bladder tissue can be analyzed.
Open Nephrectomy
An open nephrectomy, which is the traditional procedure, involves making an incision in the patient’s abdomen or side. It offers excellent access to the kidneys, as well as other organs, for more complicated cases.
Laparoscopic Nephrectomy
A laparoscopic nephrectomy, which is less invasive, requires four small incisions; it is performed using a tiny camera and small instruments. It has many advantages over traditional surgery: less bleeding, scarring and pain, and a shorter recovery time. It is not, however, appropriate in all cases.Radical NephrectomyWith a radical nephrectomy, the entire kidney, the surrounding lymph nodes, and the adjacent adrenal gland are removed. It may be performed when malignant tissue has spread from the kidney to surrounding tissue.
Risks of Nephrectomy
Every surgical procedure has risks, including excessive bleeding, adverse reactions to anesthesia or medications, post-surgical infection and damage to adjacent organs. Risks specific to nephrectomy include malfunction or failure in the remaining kidney, and hernia of the surgical wound.
Recovery from Nephrectomy
Depending on the type of nephrectomy, a hospital stay of from 2 to 7 days is required. A patient who has had a laparoscopic nephrectomy usually recovers in 4 weeks, whereas one who has had an open nephrectomy may require 6 weeks. Strenuous physical activity may be restricted for a longer period. During the post-surgical hospital stay, a patient can expect the following:
- Catheterization for 24 to 48 hours
- Surgical-wound drain
- Inability to eat for a few days
- Liquid diet (when capable of eating)
- To perform breathing exercises
- To wear special stockings and/or take medications to prevent blood clots
A patient in good general health can usually function normally with one kidney, whereas a patient with advanced kidney disease may need a kidney transplant or long-term dialysis.