When your doctor tells you or someone you know that you need to have a surgery called a 'nephroureterectomy', you may feel a little scared and nervous upon hearing the name. It's a very big, complicated word. In fact, anyone can get a little scared when they hear this name. But don't be afraid. Today, let's talk about this in a simple way, as if you were talking to a friend. We'll talk about what it is, why it's done, and how it happens.
What is Nephroureterectomy?
This is a bit of a long word, so let's break it down first and understand it.
- Nephro-: This comes from a Greek word. It means "kidney."
- Ureter: This is the tube that carries urine produced in our kidneys to the bladder.
- Ectomy (-ectomy): This means "to surgically remove" .
Simply put, a nephroureterectomy is a surgical procedure that removes several parts of your body. These are the parts that are removed:
- One kidney completely.
- The entire ureter connected to that kidney.
- A small piece of tissue where the urethra connects to the bladder is called the bladder cuff.
Why do you need to have this kind of surgery?
A doctor will often recommend this surgery if you have cancer in your upper urinary tract, that is, your kidneys or urethra (urothelial cancer or transitional cell cancer). This is usually considered a "radical" surgery .
What is a "radical" operation? It means that the doctor removes not only the cancer, but also any surrounding tissue or organs where the cancer may have spread. For example, if the cancer has spread to nearby lymph nodes, the kidney and ureter may be removed along with those lymph nodes. The main goal of this is to completely remove the cancer from the body and reduce the risk of it coming back.
How to prepare before surgery?
Before the surgery, you will meet with your doctor. He or she will discuss your medical history and check your height, weight, and blood pressure to see if you are ready for surgery. This is an important time for you. Talk to your doctor about any questions or concerns you may have.
There are a few things you should definitely tell your doctor:
- You should tell your doctor about all the medications you are taking: prescription medications, over-the-counter (OTC) medications, vitamins, herbal remedies, and Ayurvedic medicines. It is especially important to tell your doctor about blood thinners like aspirin.
- Allergies: Be sure to tell your doctor if you have any allergies to certain medications, skin cleansers like iodine, foods, or latex.
Your doctor will also give you instructions on what to eat and drink the day before surgery. They will usually tell you to eat only clear liquids for 24 hours before surgery, and not to eat or drink anything for about 8 hours before surgery. It is very important for your safety to follow these instructions exactly.
What are the main methods of performing this surgery?
There are two main methods for performing a nephroureterectomy. Let's look at the differences between the two.
| Surgical method | Simply put... |
|---|---|
| Open nephroureterectomy | This is the traditional method. The doctor makes one or two large incisions in your abdomen. Sometimes a rib may also need to be removed. This method is used if the cancer is very large or in a place that is difficult to remove. |
| Robotic-assisted laparoscopic nephroureterectomy | This is the most modern and widely used method. It involves making only 3-5 very small incisions (keyhole incisions) in the abdomen. A thin instrument (laparoscope) with a camera attached is inserted through these incisions and the internal organs are magnified on a computer screen. The surgeon controls the arms of a robotic machine to perform the surgery with great precision and precision. |
Laparoscopic surgery using robotic technology has many advantages, such as smaller scars, less pain, and faster recovery.
What happens after the surgery?
The surgery usually takes about two to four hours. After that, you will be taken to the recovery room. Doctors and nurses will take good care of you until you regain consciousness.
- Pain: It is normal to feel some pain after surgery. You will be given painkillers to help with this.
- Nausea: Some people may experience nausea due to anesthesia. There are medications for that too.
- Food: Liquid food is given for the first one or two days. Then, gradually introduce regular food.
- Walking: You will be encouraged to walk from the day after surgery. Although it may be difficult, this is very important. Walking can help prevent blood clots in the legs and pneumonia.
You will usually be able to go home in a few days, but you will need to have a family member or friend to take you home.
How is the recovery time after going home?
After you go home, you need to get plenty of rest. You should allow yourself time to fully recover, which usually takes about six weeks .
- Driving: Avoid driving for at least two weeks.
- Heavy lifting: Avoid strenuous activities such as lifting more than 20 pounds (about 9 kilograms) or running for about 6 weeks. These can damage the stitches and cause conditions such as hernias.
- Walking: Walking is a great way to exercise.
Your body may heal at a different rate than others. So, listen to your body. If it's hard, rest.
When should you see a doctor immediately?
You will be given a follow-up appointment, that is, a date to see the doctor again. Be sure to go to those dates. Then the stitches will be checked and, if necessary, cut and removed. However, if any of the following symptoms appear, call your doctor immediately or go to the hospital's Emergency Treatment Unit (ETU).
| Feature to pay attention to | Description |
|---|---|
| High fever | If the body temperature is 100 Fahrenheit (38 Celsius) or higher. |
| Bleeding from the incision site | If the bleeding is heavy and won't stop. |
| Abnormal discharge | If there is a foul odor or yellow/green pus coming from the incision. |
| Increasing pain | The pain is getting worse day by day, and it cannot be controlled even with medication. |
| Seam separation | If the stitches at the incision site come loose and the wound opens. |
It's normal to feel scared, anxious, and unsure before undergoing surgery. "Will the surgery be successful?", "What if the cancer has spread to other parts of the body?", "Will the recovery be difficult?", etc. Don't hold onto these feelings. Talk to your doctor and family about it. The more you know about this surgery, the less scared you will be.
Take-Home Message
- Nephroureterectomy is a surgical procedure that removes a kidney, its associated ureter, and a small portion of the bladder. It is mainly performed as a treatment for cancer.
- There are both open and laparoscopic (keyhole) methods for performing this surgery. The laparoscopic method is less painful and less scarring.
- It is essential to tell your doctor about all medications and allergies you are taking before surgery.
- It may take about 6 weeks to fully recover. Avoid heavy lifting during this time.
- If you notice anything during your recovery, such as fever, severe pain, or unusual discharge from the wound, seek medical advice immediately.
- Talk openly with your doctor about any questions or concerns you may have. They are always ready to help you.
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