Laparoscopic nephroureterectomy is surgery to remove a kidney and ureter. This surgery may be needed for cancer in a kidney or ureter. Your two kidneys are organs that filter your blood. They remove waste chemicals and extra water to make urine. Ureters are tubes that carry urine from your kidneys to your bladder.
For the surgery, a tool called a laparoscope (scope) is used. This is a thin, lighted tube with a camera on the end. The scope lets the provider work through a few small cuts (incisions). In most cases, after surgery your body can still work well with only one healthy kidney and ureter.
Getting ready for surgery
Follow any instructions from your healthcare provider.
Tell your provider about any medicines you are taking. You may need to stop taking all or some of these before the test. This includes:
All prescription medicines
Blood-thinning medicines (anticoagulants)
Over-the-counter medicines such as aspirin or ibuprofen
Herbs, vitamins, and other supplements
Do not eat or drink during the
8hours before your surgery. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)
Prepare your bowel for surgery
1 to 2days before the surgery, if you have been told to. You may need to limit your diet to only clear liquids. You may also be asked to take laxatives or to give yourself an enema. Follow your healthcare provider’s instructions.
The day of surgery
The surgery takes
Before the surgery begins:
An IV (intravenous) line is put into a vein in your arm or hand. This line supplies fluids and medicines (such as antibiotics).
You may be given medicine to prevent blood clots.
To keep you free of pain during the surgery, you’re given general anesthesia. This medicine puts you into a state like a deep sleep through the surgery. A tube may be put into your throat to help you breathe.
During the surgery:
The provider makes a few small incisions and one slightly larger incision in your belly (abdomen).
The scope is placed through an incision. It sends live pictures of the inside of your abdomen to a video screen.
Your abdomen is filled with gas. This makes space for the provider to see and work.
Using tools placed through the incisions, the kidney and ureter are prepared for removal. The small piece of tissue where the ureter connects to the bladder (bladder cuff) is detached.
The kidney, ureter, and bladder cuff are removed through the larger incision. Nearby lymph nodes may be removed as well.
When the surgery is complete, all tools are removed. The incisions are closed with stitches or staples.
A thin tube (Foley catheter) is placed in your bladder. This will drain your urine while your bladder heals.
Note: The provider will begin with laparoscopy. But he or she may need to change to open surgery for safety reasons. Open surgery is done using an incision in your abdomen or side. You’ll be told more about this possibility before surgery.
Recovering in the hospital
After the surgery, you will be taken to a recovery room. Here, you’ll wake up from the anesthesia. You may feel sleepy. You may have an upset stomach (nausea). If a breathing tube was used, your throat may be sore at first. When you are ready, you will be taken to your hospital room. While in the hospital:
You will be given medicines to manage your pain. Let your provider know if your pain is not going away.
You’ll first receive IV fluids. In a day or so, you’ll start on a liquid diet. You’ll then slowly return to a normal diet.
You’ll be taught ways to cough and breathe that can keep your lungs clear and prevent pneumonia.
The Foley catheter may be removed while you’re in the hospital. If not, you’ll be taught how to care for it at home.
Recovering at home
After your hospital stay, you will be released to an adult family member or friend. Have someone stay with you for the next few days, to help care for you. Recovery time varies for each person. Your provider will tell you when you can return to your normal routine. Until then, follow the instructions you have been given. Make sure to:
Take all medicines as directed
Care for your incisions and catheter as instructed
Follow your provider’s guidelines for showering. Avoid swimming, bathing, using a hot tub, and other activities that cover the incision with water until your provider says it’s OK.
Avoid heavy lifting and strenuous activities as directed
Avoid driving until your provider says it’s OK. Do not drive if you’re taking medicines that make you drowsy or sleepy.
Walk at least a few times a day. Increase your pace and distance, as you feel able.
Avoid straining to pass stool. If needed, take stool softeners as directed by your provider.
Drink plenty of water. This helps prevent urine odor and dehydration. Follow any special diet instructions from your provider.
Call your provider if you have any of the following:
Chest pain or trouble breathing (call 911 or your local emergency number)
100.4° For higher
Symptoms of infection at incision site. These include increased redness or swelling, warmth, more pain, or bad-smelling drainage
Bloody urine or drainage from the catheter that is dark red or has clots (a small amount of blood is normal)
No drainage from the catheter for more than
The catheter comes out of your bladder
Pain that can’t be controlled with medicines
Pain or swelling in your legs
You’ll have follow-up visits so your provider can check how well you’re healing. If your stitches, staples, or catheter need to be removed, this will likely be done in
Risks and possible complications
All procedures have some risk. The risks of laparoscopic nephroureterectomy include:
Bleeding (may require a blood transfusion)
Hernia at the incision sites
Damage to nearby nerves, blood vessels, soft tissues, or organs
Cancer returning or tumor seeding (spillage of tumor cells that can grow into new tumors)
Problems with the remaining kidney, which could lead to kidney failure
Heart attack or stroke
Risks of anesthesia (the anesthesiologist will discuss these with you)