Download nephrectomy - Tameside Hospital

NEPHRECTOMY
(RADICAL OR SIMPLE REMOVAL OF KIDNEY)
AN INFORMATION LEAFLET
Written by: Department of Urology
May 2011
Stockport: 0161 419 5698
Website: www.stockport.nhs.uk
Tameside: 0161 922 6696/6698
Website: www.tameside.nhs.uk
Macclesfield: 01625 661517
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What Is A Ne phre ctom y?
Most people have two kidneys, one at each side at the back of the abdomen. They filter the blood in
your body to remove waste products, which are passed out of the body in your urine. Urine is carried
by a tube (ureter), leading from each kidney to the bladder. When the bladder is full, urine passes
out of your body through a tube called the urethra.
A simple nephrectomy involves removing the whole of one kidney.
A radical nephrectomy is the removal of one kidney and the surrounding tissues. These include; the
adrenal gland which is attached to the kidney and some lymph nodes situated near the kidney. In
some cases the ureter is also removed (this would be called a nephroureterectomy).
In order to get to the kidney, the Urological Surgeon will usually make a cut (incision) between the
lower ribs on the same side as the affected kidney. Part of a rib may be removed to make it easier to
remove the kidney.
The operation is carried out under a general anaesthetic (when you are asleep) and usually requires a
stay of about five to seven days.
What Are The Benefits?
Nephrectomy can be carried out beacause;
• your kidney is damaged and not working properly
• you have cancer in your kidney
• the kidney is damaged due to chronic infection
• the kidney is damaged due to injury to the kidney
• the kidney is not working properly due to kidney stones
• in order to donate a kidney
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The aim of the operation is to remove the kidney, which is affecting your health. If cancer is present,
the aim is to remove all the cancer, so that the extent of the disease can be assessed (staging) and
will help the urology doctors decide if you need further treatment.
Are There Any Risks Involved?
•
Pain – The Ward staff will give you painkillers to control any pain you may have. This may be in the
form of a device that you use to control your pain yourself. This is known as a patient
controlled analgesia (PCA) and you will be shown exactly how to use it. Pain relief may also
be administered by an epidural (needle inserted in your back).
•
Anaesthetic risks - there is a risk of dying as a result of the operation or the anaesthetic. How big the
risk is depends on the operation you are having and your general health. You will be given
more information about the risks before you sign a consent form to say you agree to have
the operation.
•
Bleeding - A blood transfusion may be needed to replace blood lost during the operation. Very
occasionally, there may be internal bleeding after the operation making further surgery
necessary.
•
Bruising or infection in the wound – If your wound appears very reddened and/or has a
discharge (pus), you may require some antibiotics.
•
Blood clots in the leg (deep vein thrombosis/DVT) – As you are not able to move around
immediately after the operation, blood clots may form in your leg, which can occasionally
lead to a clot in the lungs (pulmonary embolus/PE). Moving around as soon as possible after
your operation can help to prevent this and you may be given special surgical stockings to
wear, whilst you are in hospital and possibly injections to thin the blood. You may also be
shown how to perform leg exercises, to help prevent blood clots occuring.
•
Chest infection – this is due to the effects of the anaesthetic and you may be taught deep
breathing exercises by a physiotherapist, which you should do regularly after your operation,
to help prevent a chest infection.
•
Pneumothorax (collapsed lung) – This is rare but can happen because the cut is close to the ribs.
If this occurs, you may need a drain (tube) in your chest until your lung recovers.
•
Possible need for further treatment – If cancer is present in the kidney and the surgeon is
unable to remove it completely, further treatment may be necessary.
Renal dialysis (a procedure to remove waste products from the blood) – In most cases you will
still have one kidney, which will continue to work. However, if you only have one kidney
initially or if your remaining kidney is not working properly after the operation or becomes
damaged you may need renal dialysis.
•
What Are The Alternatives?
In some cases it may be possible to perform:
a partial nephrectomy (only the affected part of the kidney is removed)
laparoscopic nephrectomy (keyhole surgery)
embolisation of the kidney (a treatment that cuts off the blood supply to the tumour).
Your surgeon will be able to tell you if any of these is suitable for you.
You may choose to do nothing, although if cancer is present, it is likely that this will progress and
your health may deteriorate.
You may wish for your care to be transferred to the palliative care team, whose aim is to improve
quality of life, rather than saving lives. If this is the case, please let us know.
How Long Will I Be In Hospital For?
Patients usually stay in hospital for approximately five to eight days after a nephrectomy but no
two patients are the same. This will depend on how well you progress following your operation.
What Happens To Me When I Arrive At The Ward?
You will usually come into hospital on the day of your operation.
You will meet the nursing staff who will be looking after you.
The anaesthetist will talk to you about the anaesthetic you will have and also discuss your options
for pain relief following the operation.
On The Day of the Procedure
You will have nothing to eat or drink for several hours before the operation. If you would normally
take tablets during this time, you can ask at the pre-operative assessment clinic which you should
continue to take.
You may be given some tablets as part of the preparation for your anaesthetic, known as a “premed”. These will help you feel more relaxed.
Before going to the operating theatre, you may be asked to take a bath or shower and change into a
theatre gown. Any make-up, nail varnish, jewellery (except your wedding ring), dentures and contact
lenses must be removed.
What Happens After the Procedure?
When you come out of theatre, you will be transferred to the recovery area before you are
transferred back to your ward. You may still be very sleepy at first and will be given oxygen through
a face mask.
If you require close monitoring, you may be nursed in the High Dependency Unit (HDU) until you
are ready to return to the main ward.
The ward staff will give you painkillers to control any pain you may have. This may be:
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A device that you use to control your pain yourself. This is known as a Patient
Controlled Analgesia (PCA) and you will be shown how to use it.
An epidural inserted in your back.
The anaesthetist will discuss these with you before your surgery. After about two days you will
probably be given pain killing tablets or injections instead. Please tell your nurse if you have any
pain or discomfort at any time.
You will have a drip running into a vein to give you fluids until you are able to drink normally, which
is usually the day following the operation. You will gradually increase your fluid and food intake over
the next few days and the drip will then be removed.
As well as a dressing over your wound, you will have a small plastic drain tube, attached to a
drainage bag. This is to drain any fluid which collects under your wound and is usually removed one
to two days after the operation.
You will have a catheter (tube into the urethra draining urine from the bladder), so that the amount
of urine you pass can be measured. This will be removed when you are more mobile.
You will be encouraged to breath deeply after your operation and move your legs in bed. The
nursing staff will help you to get out of bed on the first and second day after the operation and help
you start walking soon after this. You are normally up and about independently about two to three
days after surgery.
Discharge Arrangements
You will normally be ready to go home about five to eight days following the operation. You will be
required to arrange for a responsible adult to collect you from hospital.
Arrangements will be made for a District Nurse to visit you at home to remove your stitches about
ten days after the operation.
You will be given seven days supply of any medications you have been prescribed and a letter will
be sent to your GP informing them of your treatment and progress.
An outpatient appointment will be arranged for you to be seen in your local urology department
about six to eight weeks after the operation.
The results of your surgery will be discussed with you, as well as any further treatment that may be
necessary.
Day To Day Living
Recovery time after this type of surgery varies but generally you should feel improvements around
two or three weeks after your operation. This may take longer if your surgery has been more
complex.
The wound can take up to eight weeks to heal fully and the scar on your side should fade with time.
During the first six weeks you should not drive and we advise that you contact your car insurers for
advice on driving following this procedure.
Going back to work will depend on the type of job that you do and how you feel. This may be
between two and three months and your GP can provide you with a sick note for the time you are
off work.
You should not lift heavy objects or do anything that might put a strain on your wound (strenuous
exercise) for around six weeks after the operation.
Drinking plenty of fluids and passing urine regularly will help keep your remaining kidney healthy.
If there is a Problem
If you have a problem following discharge from hospital, please contact your GP for advice.
Other Useful Contacts or Information
It is important that you have as much information as you would like before you agree to have this
operation. If you have any questions about your treatment, do not be afraid to ask your doctor or
nurse.
You may be feeling a wide range of emotions and for some people undergoing surgery can be a
frightening and unsettling time. It may help you to talk about how you are feeling to someone who
specialises in dealing with this condition, such as your Urologist or the Urology Specialist Nurse.
They will listen, answer any questions you may have, or can put you in touch with other
professionals or support agencies if you wish. Some useful contact numbers are listed below;
Macmillan Cancer Support
89 Albert Embankment
London
SE1 7UQ
0808 808202
www.macmillan.org.uk
(provides specialist advice through Macmillan nurses and doctors and financial grants for people
with cancer and their families)
Cancer Backup
Bath Place
Rivington Street
London
EC2A 3JR
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0808 8001234 (freephone information line, Monday to Friday, 9am to 7pm)
www.cancerbackup.org.uk
(provides information on all aspects of cancer and its treatment and on practical and emotional
problems of living with cancer)
Greater Manchester and Cheshire NHS Cancer Network website
www.gmccn.nhs.uk
(website with information about all aspects of cancer and details of support for people affected by
cancer).
Kidney Cancer UK
Administration
Office PO Box 2473
Uttoxeter
Staffordshire
ST14 8WZ.
01889 565801
www.kcuk.org
If you have any questions you want to ask, you can use this space below to make notes to remind
you.
Source
In compiling this information leaflet, a number of recognised professional bodies have been used,
including Greater Manchester and Cheshire Cancer Network and the British Association of
Urological Surgeons. Accredited good practice guidelines have been used.
If you have a visual impairment this leaflet can be made available in bigger print
or on audiotape. If you require either of these options please contact the Health
Information Centre on 0161 922 5332
If you would like any further information please telephone the Urology Nurse Specialists at your
local Urology Department on:
Stepping Hill
Tameside
Macclesfield
0161 419 5695
0161 922 6696/6698
01625 661517
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Nephrectomy
Urology Department
Elective Services
May 2008
Version 1.2
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