Radical nephroureterectomy is a surgical procedure performed to address medical conditions affecting the urinary tract. This operation involves the removal of specific organs and tissues to treat disease. Understanding this surgery is important for patients and their families.
Understanding Radical Nephroureterectomy
Radical nephroureterectomy involves removing the kidney, the entire ureter, and a small section of the bladder where the ureter connects. The goal of this surgery is to remove a tumor and any surrounding tissue affected by disease. It is considered a radical surgery because it targets the diseased area and adjacent structures to ensure thorough removal of cancerous cells.
The kidney is a pair of bean-shaped organs located on each side of the spine, responsible for filtering waste products from the blood and producing urine. The ureter is a narrow, muscle-lined tube that transports urine from the kidney to the bladder. The bladder cuff refers to a small piece of bladder tissue removed along with the ureter.
Medical Conditions Requiring Surgery
Radical nephroureterectomy treats upper tract urothelial carcinoma (UTUC). UTUC is a cancer originating in the lining of the upper urinary tract, specifically the renal pelvis or ureter. These cancers are similar to bladder cancers because the cells lining these structures are of the same type.
UTUC accounts for less than 5% of all kidney cancers and 5-10% of all urothelial malignancies. Smoking is a significant risk factor. UTUC commonly presents with blood in the urine, and larger tumors can obstruct urine flow, causing back pain. This surgery is the standard treatment for high-grade, bulky, or invasive tumors.
The Surgical Process
Preparation for radical nephroureterectomy involves a thorough medical evaluation to assess a patient’s health, including medical history and current medications. Patients are typically advised to stop certain medications, like aspirin and anti-inflammatory drugs, before surgery to reduce bleeding risk. The procedure generally requires general anesthesia and can take approximately six hours.
Two main surgical approaches are used: open surgery and minimally invasive techniques, such as laparoscopic or robotic-assisted surgery. Open surgery involves one or two large incisions, typically between 8 and 12 inches long, in the abdomen; sometimes a rib may be removed to access the kidney. This approach may be necessary for very large or difficult-to-reach tumors.
Minimally invasive techniques involve several smaller incisions, often between three and five, through which a laparoscope (a thin, lighted tube with a camera) and specialized surgical instruments are inserted. Robotic-assisted surgery uses a surgical robot controlled by the surgeon, providing enhanced visualization and precise movements. Benefits of minimally invasive approaches include less blood loss, a shorter hospital stay, faster recovery, and reduced post-operative pain. The organs are removed intact through one of the incision sites.
Post-Surgical Recovery and Outlook
Immediately after radical nephroureterectomy, patients can expect a hospital stay, typically around two days. Pain management is provided to help alleviate discomfort around incision sites. Patients often have a urinary catheter for approximately one week post-surgery, and a surgical drain may also be present to collect excess fluid.
Long-term recovery involves a gradual return to normal activities, with full energy potentially taking three to six months. Patients are encouraged to walk daily to improve blood flow and prevent complications like pneumonia and constipation. Lifting heavy objects or strenuous abdominal exercises is typically restricted for at least four weeks. Potential complications include infection, bleeding requiring a transfusion, hernia, injury to surrounding organs, and in rare cases, kidney failure.
The body can function effectively with one healthy kidney, and many patients recover well. Overall complication rates range from 9.4% to 14.9%, with common issues including urinary tract infections, surgical site infections, and gastrointestinal problems. Follow-up care monitors recovery and detects any disease recurrence. For patients with low-grade kidney tumors, recurrence-free survival rates can be as high as 86–95% after this procedure.