Patient education: Nephrectomy (The Basics)

What is nephrectomy? — This is surgery to remove a kidney. You might need a nephrectomy:

●To treat kidney cancer or a growth in your kidney

●If you are donating a kidney to someone else

●To treat very serious kidney disease

●If your kidney was injured in an accident

●If a kidney has not developed normally

In some cases, the doctor will remove the whole kidney. In other cases, they will only remove part of the kidney. Sometimes, the doctor will also remove the ureter (figure 1). This is the tube from the kidney to the bladder that urine flows through.

This surgery can be done in 2 ways:

●Open surgery – The doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – This lets the doctor make 1 or more smaller incisions in the skin. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (this is called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for nephrectomy? — The doctor or nurse will tell you if you need to do anything special to prepare. This often depends on why your kidney is being removed.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●X-rays, ultrasound, CT scan, or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●If you will need dialysis after your kidney is removed

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during nephrectomy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make 1 or more incisions in your skin and remove your kidney.

●In some cases, the doctor will place a drain tube in the area where the kidney was removed. This helps remove any fluid that collects where the kidney was removed.

●The doctor will close your incisions and cover them with clean bandages.

What happens after nephrectomy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people can go home within a day or 2. Others stay in the hospital longer.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you might start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of nephrectomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Major risks include:

●Bleeding

●Infection

●Damage to nearby organs

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Nephrectomy – Discharge instructions (The Basics)
Patient education: Kidney cancer (The Basics)
Patient education: Kidney transplant (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Polycystic kidney disease (The Basics)
Patient education: End-stage kidney disease (kidney failure) (The Basics)

Patient education: Renal cell carcinoma (kidney cancer) (Beyond the Basics)
Patient education: Chronic kidney disease (Beyond the Basics)
Patient education: Polycystic kidney disease (Beyond the Basics)