What is Radical Nephrectomy?
Radical nephrectomy is a surgical procedure performed to remove an entire kidney. If required, additional structures such as the adrenal gland (located on top of a kidney) or lymph nodes present around the kidney are also removed along with the kidney.
In some cases, only the diseased part of the kidney needs to be removed, leaving the rest of the healthy kidney intact. This procedure is known as partial nephrectomy.
Who Needs Radical Nephrectomy?
People going through the following conditions may require a radical nephrectomy:
- Kidney Infection: Kidneys also form a part of the urinary tract along with the ureters, urethra, and bladder. If any of these parts are exposed to bacteria, it can cause a urinary tract infection (UTI), even putting the kidneys at risk. In such cases, the affected kidney may need to be surgically removed.
- Kidney Cancer: When the cells of a kidney become malignant or cancerous, their uncontrolled growth can cause a tumour and a swollen kidney. So, surgery is vital to prolong the patient’s life and prevent the spread of cancer to other body organs.
- Chronic Kidney Disease: It is a condition when the kidney stops working for more than three months. The most common reason for chronic kidney disease is high blood pressure and diabetes. So, when the kidney fails to remove toxins from the body, high levels of waste start building up in the blood, resulting in extreme sickness for the patient. This is why surgery is needed to remove the kidney.
- Traumatic Kidney Injury: Even though the back muscles and the rib cage protect the kidneys, severe injuries can cause disabling damage. Mainly two types of injuries can lead to a traumatic kidney injury:
- Blunt Trauma: Injury due to a physical attack or a forceful impact by an external object without piercing the skin.
- Penetrating Trauma: When an external object pierces the skin, creating a wound inside.
- Kidney Donation: Another reason for a radical nephrectomy is kidney donation. In the surgery, the patient’s damaged kidney is removed and replaced by a healthy one. In many cases, people donate a kidney to someone in need.
What May Happen if Radical Nephrectomy is Delayed?
If one or both kidneys fail to perform their function, high levels of toxins and excess fluid may build up in the blood, causing weakness, shortness of breath, or even abnormal heart rhythms. This may lead to severe health risks if it remains untreated. Radical nephrectomy removes the damaged kidney so the patient may lead a fulfilling life with one healthy kidney.
In the case of a renal tumour, delaying radical nephrectomy may adversely affect the treatment outcomes if delayed for more than three months.
How is Radical Nephrectomy is Performed?
Radical nephrectomy is the removal of the entire kidney from the body. A urologist or a urology surgeon usually performs this surgery. Along with the kidney, a surgeon may remove the fatty tissues surrounding the kidney and a small portion of the tube that connects the kidney to the bladder. If a renal tumour also affects the adrenal gland (positioned on top of the kidney), it may also need to be removed.
Radical nephrectomy is performed under the following procedures:
- Open Nephrectomy: In this procedure, a urology surgeon makes an incision on the side of the patient’s body. This type of surgery allows the surgeon to perform the procedure safely, which still cannot be performed using less invasive methods in many cases.
- Laparoscopic Nephrectomy: A surgeon makes a few small incisions over the abdomen of the patient’s body to insert a tube-like device inside a person’s body. The device is equipped with a video camera and small surgical tools.
- Robot-Assisted Laparoscopic Surgery: This procedure is a variation of laparoscopic surgery, in which a surgeon performs the surgical procedure with the help of a robotic system. The robotic system can perform complex motions effectively, as a surgeon’s hand would perform in open surgery. The tools used in this method require relatively smaller incisions and provide better 3-D images.
What to Expect During the Radical Nephrectomy?
- An anaesthesiologist induces general anaesthesia so that the patient remains asleep and doesn’t feel any pain during the surgery
- An intravenous (IV) line is started in the arm and hands to supply IV fluids and medications to the body
- The healthcare providers may also place a urinary catheter (a small tube to drain urine from the bladder)
In case of open surgery,
The patient will be placed on his/her side to make an 8-12 inches long incision just below the ribs to remove the damaged kidney
In the case of laparoscopic surgery,
- The surgeon makes three to four small incisions not longer than an inch in the patient’s belly and side
- The procedure is performed with the help of microscopic probes and a camera
- Towards the end of the procedure, the surgeon makes a cut of about 4 inches to remove the swollen or damaged kidney from the body
- After the surgery is complete, he/she closes the incisions with the help of sutures and stitches
When to Consult the Doctor?
The patient must visit the doctor every year for a checkup of the remaining kidney. Every few years, the patient must also test the kidney functions to measure the creatinine and glomerular filtration rate (GMR). The doctor will examine blood pressure and urine in the tests. If any presence of protein is detected in the urine, it may be because of some defect in the remaining kidney.
After the surgery, the patient must take extra precautions. If any of the following symptoms are observed, he/she must call the doctor immediately:
- Fever over 100°F
- Drainage from the incisions
- Increased pain around the incision site
Risks and Complications Involved in a Radical Nephrectomy
Radical nephrectomy bears the risks of the following complications:
- Blood clotting
- Drainage from the surgical site
- Post-surgery infection
- Allergic reaction from anaesthesia (in rare cases)