Nephrectomy – Purpose, Procedure & Recovery Stages

Kidney disease not only affects the kidney but also the whole person. This modern proverb tries to say that health issues in the kidney affecting the kidneys might worsen the overall health status of a person.

In 2022, more than 102,000 kidney transplants will have been made worldwide. 10% of the global population is affected by chronic kidney disease (CKD). Here, the kidney is highlighted because it has great importance. Let’s have a look at the nephrectomy, which might be needed for some major kidney issues. 

What is Nephrectomy?  

Nephrectomy is a surgical method used to remove either a part or all of the kidney. This procedure is mostly done to remove a tumour that isn’t cancerous or treat kidney cancer.

A doctor who performs this surgery is known as a urologic surgeon. Nephrectomy has two main types of procedures. Radical nephrectomy involves the removal of a whole kidney. 

What is a nephrectomy?

A nephrectomy refers to the method of surgically removing one kidney. Bilateral nephrectomy is the method of surgically removing both kidneys.

There are two types of nephrectomy methods:

1) Partial nephrectomy: This is a procedure in which a surgeon removes only the diseased part of the kidney. The patient might have either a laparoscopic or robotic partial nephrectomy or an open partial nephrectomy.

2) Radical nephrectomy: This is a method in which a surgeon removes the whole kidney. Surgeons might remove the adrenal glands (hormone glands just above the kidneys).

This might be done as an open, laparoscopic, or robotic method. They might also clear off a portion of the ureter (tube connected to the bladder) in a method known as nephroureterectomy.

Differences between laparoscopic and open surgery

There are two different methods of nephrectomies. A laparoscopic nephrectomy is a method in which a small tool with a camera (laparoscope) and small incisions are used. 

A robotic-assisted laparoscopic is a method in which a surgical robot is regulated by the surgeon to handle the small tools. In an open nephrectomy, a large incision is used, through which the surgeons see inside the body directly and do not use a camera. 

Laparoscopic nephrectomy might require shorter hospital stays and provide quick recovery times. However, surgeons might use open surgery if laparoscopic surgery is not preferred.

Some might have a large kidney tumour, so the minimally invasive techniques might not suit them. For them, an open surgery could be a safer and better option. 

Why is a nephrectomy (kidney removal) done?

A nephrectomy may be needed in the following conditions:

1) Kidney damage (from kidney stones or disease): Kidney stones blocking the flow of urine can cause damage to your kidneys and then result in kidney disease.

2) Congenital defect: In the congenital defect, either one or both kidneys might have formed abnormally (renal dysplasia).

The kidneys might either be in the wrong position, or they might be joined to form a single arched or horseshoe kidney. One or both kidneys might contain fluid-filled cysts (polycystic kidney disease or multicystic kidney disease).

3) Kidney cancer: Kidney cancer grows whenever the cells in your kidneys develop out of control. The treatments for kidney cancer are surgery, chemotherapy, and radiation therapy.

4) Traumatic injury : Traumatic injury refers to injuries occurring at a sudden onset, whose severity might need immediate medical attention. The insult might result in a systemic shock known as “shock trauma” and might need immediate interventions to save life.

5) Kidney donation: Kidney donors live a healthy life with one kidney. After the kidney donation, the remaining kidney could increase in size and handle the filtering job in your blood. Kidney transplants can be divided into deceased-donor or living-donor transplantations based on the source of the donor organ.

Why is kidney removal performed?

The main purpose of the nephrectomy is to remove the tumor from the kidney. A tumor in the kidney might be cancerous or benign (noncancerous).

A few people might require a nephrectomy if there are repeated infections or if the kidney is not working. The nephrectomy is also used by the surgeons to remove a healthy kidney for a kidney donation.  

Nephrectomy Procedure

The nephrectomy involves the following steps before, during and after the kidney surgery.

1) Before Nephrectomy

Before kidney surgery, your doctor will instruct you on how to prepare for the Nephrectomy procedure. You must stop taking some medicines, like blood thinners, for some days before the operation.

Your surgeon will ask you to have fasting (not eat) and stop drinking the liquids just the night before the Nephrectomy procedure.  

A few days before surgery, your doctor will take out the blood. This blood test will tell you whether you need a blood transfusion and will inquire about the baseline kidney function and blood counts.  

2) During Nephrectomy

Your surgeon might use either laparoscopic or open surgery. For either kidney removal method, you will get general anaesthesia. Anesthesia is a medicine that makes sure that you remain asleep so that you don’t feel anything.

At the time of laparoscopic nephrectomy, your surgeon might follow the below steps :

• Make one or more very small incisions in your abdomen or side.
• Through that incision, your surgeon will insert a narrow wand connected to a camera (laparoscope).
• Observes the camera image from the laparoscope on a large screen.
• Use this observed camera image and small surgical tools to successfully clear off the diseased portion of your kidney or your whole kidney.
• After the successful completion of the surgery, your surgeon closes all the incisions with small stitches. These small stitches will dissolve on their own over time.

During an open nephrectomy, your surgeon will perform the following:

• Make one incision in your abdomen.
• It clears off the diseased part of your kidney or your entire kidney.
• Closes the incision with the small stitches.

3) After Nephrectomy

You must be in the hospital for two to five days after surgery. The duration of your stay in the hospital will depend on the type of nephrectomy you had. Your doctor’s team will notice your electrolytes, blood pressure, and fluid levels.

Then, you must use a urinary catheter (a hollow tube to drain urine) for the first few days after the surgery.

Due to the incision, you might see some numbness. Your healthcare providers will provide you with pain management as required. This is because your incision might have been done near your diaphragm (the muscle under your lungs).

That incision might make it uncomfortable for you to breathe. However, performing diaphragmatic breathing exercises helps prevent pneumonia (lung infection).

What factors determine how many kidneys have to be removed?

The amount of kidney tissue that has to be removed depends on the factors given below:

• Whether a tumour is limited only to the kidney or has spread outside it or not.
• Whether there is more than one tumour or not.
• The percentage of the kidney affected by it.
• Whether the cancer has affected the nearby tissue or not. 
• How well the other kidney works.
• Whether the other diseases affect kidney function or not.
• Overall function of the kidney. 

The surgeon will decide according to the results of the imaging tests. The imaging tests might include:

1) Computerized tomography (CT): An X-ray series is used to create three-dimensional views of organs and tissues.

2) Magnetic resonance imaging (MRI): The magnetic resonance imaging (MRI) test uses the magnetic field and radio waves to make detailed images inside the body.

3) Angiography: In an angiography, the X-rays are used to check if any blood vessels are fueling the tumor. Before taking X-rays, a special type of dye is injected into the body. This test is often a part of an MRI or CT scan. 

4) Ultrasound: In the ultrasound method, sound waves are used to create a picture of organs and tissues.

Risks of Nephrectomy

The risks and complications are based on the type of surgery, the reasons for surgery, many other issues, and your overall health. Nephrectomy is a very safe procedure, but like other surgeries, it has risks like:

• Injuries in the nearby organs.
• Pneumonia after surgery.
• Reactions to medicine that prevent pain during surgery are known as anaesthesia.
• Other serious issues, like kidney failure.

A few people could face long-term issues from a nephrectomy. These issues might be caused by having less than two working kidneys. The issues that might occur because of the decreased kidney function are:

• High blood pressure or hypertension.
• Excessive amount of protein in the urine, which is a sign of kidney damage.
• Long-term kidney disease.

A single healthy kidney can do the work of two kidneys. However, most of the kidney donors live a long, healthy life even after nephrectomy. 

Symptoms of nephrectomy

Nephrectomy may show many symptoms. The symptoms of nephrectomy include:

• Burning or pain during urination.
• Urgency to urinate, but not able to pass more urine.
• Flank pain is below the rib cage and above the waist on either side of the back.
• A fever.
• Urine with blood.

When to Call the Doctor?

You must immediately seek healthcare if you notice any of the symptoms of kidney failure. You must call your healthcare provider if you see:

• Changes in urination, like frequent urination.
• Changes in the colour of the urine.
• Increase in high blood pressure.
• Edema (swelling) in the legs, lower back, or face.
• Nausea or vomiting.
• Brain fog.

Medications After Nephrectomy

The patient, after nephrectomy, might have to take two acetaminophen (Tylenol) every four hours if required for pain. This might be needed for the first several days.

You may also use the prescription pain pills along with the acetaminophen every four hours. As the prescription medication might contain acetaminophen, do not consume more than 3000 mg of acetaminophen per day.

Your doctor might prescribe a stool softener to avoid the stress after surgery. Eat plenty of fibre, drink enough water, or take the prescribed over-the-counter stool softener to prevent constipation.

It might take some days for your first bowel movement after surgery.

Foods to Eat after a Nephrectomy

After the nephrectomy or kidney donation, you must talk to a dietitian and doctor about the changes you must make to your diet.

• Eat less protein-rich foods like meat, eggs, fish, milk products, or beans. This is because too much of their consumption might stress the kidneys.

• Minimize the amount of salt in your diet. Avoid eating pretzels, chips, canned meat, fish, popcorn, and poultry. Don’t add salt to your food, and restrict it if you eat food from restaurants. If there is a large amount of salt in your food, then the remaining kidneys should work harder to filter those salts.

• Minimize the amount of phosphorus you include in your food. When your kidneys do not work well, then the phosphorus levels in your blood might rise. This might cause issues like joint pain. Your dietitian may suggest you limit foods that are high in phosphorus, such as seeds, peanut butter, and beans.

• Drink enough water, but not an extra amount of water. Lower the fluid you take in, like coffee, tea, soup, gelatin dessert, and ice cream. This is because extra fluids could stress your kidneys.

• Do not drink alcohol or limit it. This is because drinking alcohol could affect the kidneys and increase your risk of cancer growth.

Also, don’t smoke after the Nephrectomy procedure to see your best results.

Conclusion

A nephrectomy is a kidney surgery that either takes out a part or the whole kidney. The major aim of this procedure is to remove a tumor that is non-cancerous or treat kidney cancer. Radical nephrectomy and partial nephrectomy are the two main types of nephrectomy.

The nephrectomy involves serious concerns before, during, and after the procedure. A patient who is going to undergo a nephrectomy must follow the medical instructions provided by his or her doctor. 

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