The kidneys filter waste and excess water from blood, producing urine. This process maintains fluid and electrolyte balance. Various health issues can impair kidney function, sometimes requiring surgery.
Why Kidney Surgery is Performed
Kidney surgery addresses conditions compromising kidney function or threatening health. This includes non-cancerous or malignant kidney tumors, where surgical removal is a primary treatment, especially for cancer.
Kidney stones often require surgery if too large to pass, causing pain, obstructing urine flow, or leading to bleeding/infection. Surgery is considered if other treatments fail.
Blockages like ureteropelvic junction (UPJ) obstruction can prevent urine drainage, causing pain, infection, or damage. End-stage renal disease often requires a kidney transplant to restore filtering functions.
Severe kidney damage from trauma, especially with life-threatening bleeding, may require repair or removal. Symptomatic, infected, or large kidney cysts/abscesses might need drainage or removal to prevent complications.
Major Kidney Operations
A nephrectomy is common for kidney tumors or cancer. A radical nephrectomy removes the entire kidney, surrounding fatty tissue, and potentially the adrenal gland or nearby lymph nodes, typically for larger growths. A partial nephrectomy removes only the diseased portion, preserving healthy kidney tissue, especially for smaller tumors, to maintain function. Both can be performed via open or less invasive methods.
Kidney stones are addressed with procedures like Ureteroscopy, which inserts a thin scope through the urinary tract to locate stones. Small stones are retrieved; larger ones are fragmented with a laser for passage or removal.
For larger kidney stones, Percutaneous Nephrolithotomy (PCNL) involves a small back incision to access the kidney, where a nephroscope breaks and removes stones. Extracorporeal Shock Wave Lithotripsy (ESWL) is non-invasive, using sound waves to shatter stones into fragments for passage.
Kidney transplantation addresses kidney failure. A healthy donor kidney is placed in the recipient’s lower abdomen, with connected blood vessels and ureter to the bladder. The recipient’s own diseased kidneys are usually left unless causing complications.
Blockages like ureteropelvic junction (UPJ) obstruction are corrected by pyeloplasty. This surgery removes the narrowed ureter segment at the renal pelvis connection, rejoining healthy sections for proper drainage. A temporary stent may assist healing.
For symptomatic kidney cysts, cyst decortication removes the outer wall for fluid drainage, preventing reaccumulation. Kidney abscesses or severe fluid collections require drainage procedures, often percutaneous with a catheter guided by imaging. Open drainage might be considered for very large or unresponsive abscesses.
Modern Surgical Techniques
Kidney surgeries have evolved from traditional open approaches. Open surgery involves a single, large 8 to 12-inch incision for direct kidney access. This method results in more pain, longer hospital stays, and extended recovery, now primarily for complex cases.
Minimally invasive techniques offer advantages. Laparoscopic surgery uses several small incisions (under 1.5 inches) for a camera-equipped laparoscope and instruments. Benefits include reduced pain, less scarring, shorter hospital stays, faster recovery, and lower risks of infection or blood loss.
Robotic-assisted surgery enhances laparoscopy. Surgeons control robotic arms from a console, translating hand movements into precise, magnified instrument actions with a high-definition, 3D view. This improves dexterity and control, reducing pain, blood loss, and recovery time, often preserving kidney function.
Endoscopic approaches insert specialized scopes through natural openings or small punctures. This allows direct visualization and treatment within the urinary tract, particularly for stones. These techniques avoid large external incisions, leading to minimal scarring and quicker recovery.
Life After Kidney Surgery
Recovery after kidney surgery varies by procedure and individual health. Hospital stays range from a few days for minimally invasive procedures to about a week for more extensive operations or transplants. Pain management is provided, and light walking is encouraged soon after surgery to aid circulation and recovery.
Full recovery can span several weeks to a few months, with less invasive techniques allowing quicker return to normal activities. Activity restrictions, like avoiding heavy lifting, are common. Long-term, individuals with one healthy kidney lead full lives, as the remaining kidney compensates adequately. Transplant recipients require lifelong medication and consistent follow-up care to maintain the new kidney’s function.