Has your doctor told you or someone you know that you need to have a surgery called "Nephroureterectomy"? When you heard that name, you were a little scared, you couldn't figure out what it was, right? It's very common. When we hear words like these, we have a lot of questions. So today, let's talk about this surgery, very simply, in a way that you can understand, as if you were talking to a friend.
First of all, what is Nephroureterectomy?
Okay, this is a bit of a long, strange word, isn't it? Let's break it down? Then it's much easier to understand.
- Nephro- (nephros): This comes from the Greek word "nephros." Its simplest meaning is "kidney" or something related to the kidney.
- Ureter: This is our "ureter." To be precise, it is the thin tube that carries urine produced in the kidneys to the bladder.
- -ectomy (-ektomi): This is also a Greek word. It means "to cut out." That is, to remove through surgery.
Now, let's see what it all means. Nephroureterectomy is a surgical procedure that removes the kidney and the entire ureter. Another thing is removed during this surgery. That is the small piece of tissue where the ureter connects to the bladder. It is called the bladder cuff .
Simply put, this surgery removes three parts of your body:
1. One kidney
2. The entire urinary tract connected to that kidney
3. Bladder cuff, a small piece of tissue where the urethra meets the bladder
Why do you need to have this kind of surgery?
Most often, a doctor will recommend this surgery if you have transitional cell cancer, also known as urothelial cancer .
This cancer develops in the tissues that line the inside of our urinary system. That is, it can develop in the kidneys, ureters, and bladder. Especially if this cancer develops in the upper part of the urinary system, that is, in the kidneys or ureters, there is a high chance that the cancer cells will spread down into the bladder.
To completely stop that risk, the kidney with the cancer, the entire ureter connected to it, and a small piece of the bladder are all removed at once. It's like removing the problem first.
This is considered a "radical" surgery . Radical surgery involves removing not only the cancer, but also any surrounding tissue or organs where the cancer is thought to have spread. For example, if the cancer has spread to nearby lymph nodes, the doctor will remove the kidney and ureter, along with those lymph nodes. This is called metastasis .
How should I prepare before the surgery?
Okay, now let's say the doctor tells you that you need to have this surgery. What should you do then? Don't worry, the medical team will explain everything to you. But it's very important for you to know these things too.
Before the surgery, you will need to see your doctor. He or she will take your complete health history and check your height, weight, blood pressure, and temperature to make sure you are healthy enough to undergo the surgery.
There are some important things you need to know and tell your doctor .
| What you need to inform | Why is it important? |
|---|---|
| Tell me about all the medications you take. | This includes prescription medications, over-the-counter pain relievers, vitamins, and even herbal supplements. Some medications, such as aspirin, can increase the risk of bleeding. So don't start or stop taking any medication without first checking with your doctor. |
| Tell us about any allergies you have. | They can be allergies to medications, skin cleansers like iodine, foods, or latex. This is very important. |
| Follow the instructions about food and drink. | You will be asked to eat only a clear liquid diet for 24 hours before surgery. You should not eat or drink anything for at least 8 hours before surgery. If you need to take any essential medications, take them with a sip of water. It is very important for your safety to follow these instructions exactly. |
What are the methods of performing this surgery?
There are mainly two methods of performing this surgery.
1. Open surgery (Open nephroureterectomy)
2. Robotic-assisted laparoscopic nephroureterectomy
Open Surgery
This is the traditional method. Here, the surgeon makes one or two large incisions in your abdomen. This incision can be about 8-12 inches long. Sometimes a rib may also have to be removed. This method may be used if the cancer is very large or has spread deep inside.
Robotic-assisted Laparoscopic Surgery
This is the most commonly used minimally invasive method today. Here's what happens:
The doctor will make 3 or 5 small incisions, about half an inch long, in your lower abdomen. Then, through one of the incisions, a thin tube with a camera attached ( a laparoscope ) will be inserted. The surgery is performed while viewing the magnified images from this camera on a computer screen.
Surgical instruments are inserted through other small incisions. These instruments are handled by a surgical robot . But don't worry, the robot doesn't do anything on its own. The surgeon sits at a console and controls the robot completely. In this method, it is possible to reach even the deepest parts of the body with great precision, without any mistakes. It's as if the doctor's hands are becoming more delicate and precise.
What happens on the day of the surgery?
An anesthesiologist will first come and give you general anesthesia. This means you will be completely asleep until the surgery is over. You will not feel any pain and will not remember anything. Then your abdomen will be inflated with carbon dioxide gas to make room for the surgeon to work.
Then the surgeon makes incisions and begins the operation.
- Open surgery involves making large incisions and removing the affected organs.
- The laparoscopic method involves making small incisions and removing the kidney and ureter using a laparoscope and robotic equipment.
Finally, the surgeon closes the incisions with stitches. Sometimes, small silicone tubes called drainage tubes may be placed to drain any blood and fluid that collects in the incisions.
A question that comes to your mind is, what happens when one kidney is removed? A healthy person can live a normal life with one kidney without any problems. The other kidney takes over and does both jobs.
This surgery usually takes about two to four hours.
What to expect after surgery?
When the surgery is over, the anesthesiologist will stop giving you the anesthesia. You will gradually start to wake up. Then you will be taken to the recovery room . There, the medical staff will carefully monitor your health.
- Pain: When you feel pain, you are given medicine for it.
- Nausea: Some people feel nauseous due to anesthesia. If so, medication is given for that as well.
- Food: The first day or two, they are given liquid food. Then they are gradually introduced to regular food.
- Walking: You will be asked to get out of bed and walk around a bit from the day after surgery. This is very important. Walking reduces the risk of blood clots in the legs and prevents conditions like pneumonia.
Once your condition is determined to be stable, you will be allowed to go home. You should definitely be accompanied by a family member or friend when you go home. It is also very good to have someone to take care of you for the first few days.
Advantages and common risks of robotic surgery
Let's look at both of these separately.
| Advantages of robotic surgery (compared to open surgery) | |
|---|---|
| Get well soon | Less time in the hospital |
| Less pain after surgery | Less need for painkillers |
| May you recover soon. | You can return to normal activities and work quickly. |
| The incisions are too small. | Less scarring |
Like any surgery, this one has some risks.
- Risks associated with anesthesia
- Wound healing problems
- Perhaps needing to donate blood
- Bacterial infections
- Blood clot (hematoma)
- Fluid collection near incisions (seroma)
Don't be afraid of these risks. Your medical team will do everything they can to prevent them and, if they occur, manage them.
What should I pay attention to after I go home?
Recovery time varies from person to person, but in general, you should rest for about six weeks.
- Driving: Do not drive for at least two weeks after surgery.
- Lifting weights: Do not lift weights heavier than 9-10 kg (about the weight of 10 liters of water). Do not do strenuous exercises like running. These can damage the stitches and cause conditions like hernia.
- Walking: Walking is very good. It helps in the healing process.
- Returning to work: If your job is not very physically demanding, you should be able to return to work in about four weeks. However, if your job involves heavy lifting or strenuous work, it may be best to take a little longer.
Do you need to see the doctor again? What are the situations that you need to talk to quickly?
Yes, definitely. The doctor will give you a day to come back. That day, he will check your incisions and stitches. If there are any stitches that don't dissolve, they will be cut out and removed in a week or two. If there are drains, they will be removed as well.
Also, tests will be done to make sure the surgery completely removed the cancer. If the cancer has spread or is of a more aggressive type, your doctor will explain your next treatment steps (e.g. chemotherapy).
If you have these symptoms, don't delay, call your doctor immediately or go to the hospital's Emergency Department (ETU).
- Excessive bleeding from cuts
- A discolored, foul-smelling pus-like fluid oozes from cuts
- Fever (over 38 degrees Celsius / 100 degrees Fahrenheit)
- Stitches are coming apart
- The pain is getting worse.
If you see something like this, don't stay home. Seek medical advice immediately.
Finally, it's normal to have fears, anxieties, and doubts before undergoing surgery like this. Questions like "What if the surgery goes wrong?", "Will the cancer spread to other parts of the body?", "Will the recovery be difficult?" may come to mind.
It's normal to have those thoughts. But at the same time, think about the benefits you'll get from this surgery. It could save your life, it could improve your quality of life. Talk to your doctor and medical team about all your concerns and fears. They are here to help you and not leave you alone on this journey.
Take-Home Message
- Nephroureterectomy is a surgery performed primarily for urothelial cancer that occurs in the upper part of the urinary system.
- This surgery removes the affected kidney, the entire ureter, and a small part of the bladder.
- Laparoscopic surgery, which uses robotic technology, is generally less painful and has a quicker recovery.
- It is very important to follow the doctor's instructions exactly before and after surgery.
- If you experience any unusual symptoms after surgery, such as fever, excessive bleeding, or pus oozing from the wound, notify your doctor immediately.
- A healthy person can live a normal life with one kidney.
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