Radical Nephro-Ureterectomy

For urothelial cancers contained in the kidney / ureter. This is a intended curative procedure, depending on staging. It involves removing the complete reno-ureteric unit with a cuff of bladder.

It can be done open or laparoscopically.

Why is it done?

• Finding of 1 or more solid lesions inside the collecting systems of the kidney or ureter (intraluminal).
• Usually presents with macroscopic hematuria and flank pain.
• Usually a Urothelial Carcinoma (previous Transitional Cell Carcinoma TCC).
• Potentially curative process if staging is negative ie. No spread of tumour.
• Staging with CT abdomen and chest Bonescan MRI if in Renal Failure o Contrast Allergy.
• Could also be done in metastatic disease with uncontrollable haemorrhaging.

How is it done?

• Patients will receive a general anaesthesia.
• Prophylactic anti-biotics is given.
• The correct kidney is identified and marked while you are awake.
• A cystoscopy will be done first with a loosening of ureter inside the bladder and tied off of the ureter in order that there will be no spilling of ureteric content in the abdomen.
• Depending on the side of the tumour 3-4 incisions will be made: 1 for the hand-port of approximately 8cm depending on the amount of sub-cutaneous fat present 1 for the camera-port 1 for the working-port (1 for the liver retractor on the right).
• The colon is reflected to reveal the retro-peritoneal space.
• The ureter is identified and cleared up to the hilum.
• The arteries are identified and marked with vessel loops More than 1 can be present. Confirmed with CT arteriography.
• Then the vein/ viens are identified and marked with a vessel loop.
• The rest of the kidney is mobilized and loosened.
• Then the ureter is mobilized all the way down into the pelvis and plucked from the bladder where it has been loosened.
• Drain are left post-operatively.
• A catheter will be left for minimum of 5 days.

What next?

• You will spend up to 5 nights in hospital.
• You will have a catheter for that time.
• A drain for 2-3 days.
• You will a trial without the catheter on the 5th day.
• Renal functions will be checked daily.
• You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
• You will be discharged as soon as your renal function has stabilised and you can function independently.
• Allow for 6 weeks for stabilization of symptoms.
• Restrict fluid intake to less than 3 L per day.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Risks

• Blood loss 20-500cc.
• May convert from a laparoscopic to open procedure.
• Wound Infection.
• Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
• NB! Each person is unique and for this reason symptoms vary!

Very Important!!

The correct side for surgery should be checked:

• CT scan present.
• Your approval.
• Prior to anaesthesia being commenced.

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Nephro-Ureterectomy Radical