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Laparoscopic Nephroureterectomy

The two kidneys are organs that filter the blood. They remove waste chemicals and excess water to make urine. Ureters are tubes that carry urine from the kidneys to the bladder. Removal of a kidney and ureter is called nephroureterectomy. This surgery may be needed for cancer in a kidney or ureter. 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 allows the doctor to work through a few small incisions. This technique of surgery is called laparoscopy. In most cases, after surgery the body can still work well with only one healthy kidney and ureter.

Front view of body outline showing kidneys, ureters, and bladder. Left kidney shows inside. Bladder cuff is at end of ureter, next to bladder wall.

Preparing for Surgery

Prepare for the surgery as you’ve been told. In addition:

  • Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.

  • Do not eat or drink during the 8 hours before your surgery. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.)

  • Prepare your bowel for surgery 1-2 days before the surgery, if you have been told to. You may need to restrict your diet to 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 3-5 hours. Afterward, you will stay in the hospital for 1-3 nights.

Before the surgery begins:

  • An IV line is put into a vein in your arm or hand. This line supplies fluids and medications (such as antibiotics).

  • To keep you free of pain during the surgery, you’re given general anesthesia. This medication puts you into a state like deep sleep through the surgery. A tube may be inserted into your throat to help you breathe.

During the surgery:

  • The doctor makes a few small incisions and one slightly larger incision in the abdomen.

  • The scope is placed through an incision. It sends live pictures of the inside of the abdomen to a video screen. 

  • The abdomen is filled with gas. This makes space for the doctor 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 to drain urine while the bladder heals.

Note: The doctor 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 the 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 and nauseated. 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 medications to manage pain. Let your providers know if your pain is not controlled.

  • 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 coughing and breathing techniques to keep your lungs clear and prevent pneumonia.

  • The Foley catheter may be removed while you’re in 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 doctor 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 medications as directed.

  • Care for your incisions and catheter as instructed.

  • Follow your doctor’s guidelines for showering. Avoid swimming, bathing, using a hot tub, and other activities that cause the incision to be covered with water until your doctor says it’s okay.

  • Avoid heavy lifting and strenuous activities as directed.

  • Avoid driving until your doctor says it’s okay. Do not drive if you’re taking medications 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 doctor.

  • Drink plenty of water. This helps prevent urine odor and dehydration. And follow any special diet instructions given by your doctor.

Call the Doctor If You Have Any of the Following:

  • Chest pain or trouble breathing (call 911 or other emergency service)

  • Fever of 100.4°F or higher

  • Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worsening pain, or foul-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 4 hours

  • The catheter comes out of your bladder

  • Pain that cannot be controlled with medications

  • Pain or swelling in the legs

Follow-Up

You’ll have follow-up visits so your doctor can check how well you’re healing. If your stitches, staples, or catheter need to be removed, this will likely be done in 7 days. During follow-up visits, tests may be done to make sure the cancer has not returned.

Risks and Possible Complications Include:

  • Bleeding (may require a blood transfusion)

  • Infection

  • Blood clots

  • Hernia at the incision sites

  • Damage to nearby nerves, blood vessels, soft tissues, or organs

  • Cancer recurrence 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)

Online Medical Reviewer: Louise Akin, RN, BSN
Online Medical Reviewer: Daphne Pierce-Smith, RN, MSN, FNP, CCRC
Last Review Date: 5/16/2012
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.