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What is Nephroureterectomy?

Nephroureterectomy is a minimally invasive procedure to remove the entire kidney along with the ureter.

When is Nephroureterectomy indicated?

It is usually performed to treat urothelial cancer of the renal pelvis and ureter, which is a certain type of carcinoma of the kidney drainage system.

What sort of preparation is needed?

The standardized preoperative preparation takes place in hospital.

 If you take anticoagulants, you should inform your doctor.

How is the procedure performed?

Nephroureterectomy can be open surgery (with skin incision), laparoscopic or robotic, under general anaesthesia. When open surgery is performed, one large incision or two small incisions are made on the abdominal region, so that the surgeon can have access to the kidney and all along the ureter.

In the laparoscopic method, some small skin incisions are made to allow for a small high-resolution camera to be inserted and transfer the image to the screen, as well as for multiple surgical instruments to pass through and be used by the surgeon and surgical group (usually 2 assistants). As for robotic-assisted surgery, this is based on laparoscopic surgery, with the only difference that all surgical instruments are connected to an apparatus giving the potential to the surgeon to operate while sitting in front of a screen and using all instruments remote from the patient.

In Nephroureterectomy, the surgeon removes the whole kidney along with the fat normally surrounding it, as well as the entire ureter all the way down to the bladder together with the small part of the bladder where the ureter enters. Following surgery, you will have a catheter inserted into your bladder through the urethra for drainage.  

Hospital stay depends on the surgical method and the patient’s health condition. On average, in open procedures hospital stay is 7-10 days (to remove sutures) and in endoscopic procedures 3-5 days. 

What about after the procedure?

Upon discharge from hospital, you will be given specific instructions.

  • If you had been taking anticoagulants before, you will be informed about when to start them again.

Also, you will be instructed about:

  • when to start intense physical exercise
  • what kind of postoperative antibiotic treatment is required
  • whether you should be followed up by an Oncologist (in case you were operated for cancer)
  • to get your histological results and accordingly be followed up by the Oncologist
  • when to undergo cystoscopy evaluation, as there is risk of bladder cancer recurrence

How does it affect the patient’s life?

It will take you at least 14 days for the trauma to heal and at least 6 weeks to fully recover.

Most people can live perfectly normal after having one kidney removed. However, their renal function should be checked on an annual basis with a simple blood test. In addition, they should follow some instructions for maintaining the normal function  of the remaining kidney. The most important of these instructions have to do with:

  • maintaining blood pressure at normal levels
  • adopting healthy nutrition -rich in fruit, vegetables, whole grain cereals and with low fat content
  • limiting salt and animal protein consumption
  • exercising on a regular basis

In addition, it is very important to have regular follow-up CT scans -every 3 months in the beginning- as well as cystoscopies and urine cytologic tests to avoid the risk of tumor recurrence in the bladder or any other part of the urinary tract.