Removal of a kidney and the ureter
This leaflet explains the operation to have a kidney and the ureter removed. This is sometimes called a ‘nephroureterectomy’.
The ureter is the tube that drains urine (wee) from your kidneys down to your bladder.
We recommend this surgery to remove a kidney and your ureter because you have a condition called TCC (transitional cell carcinoma). This cancer can form in the kidney and ureter.
The operation usually takes about 4 hours.
Sometimes we need to remove the lymph nodes around your kidney or ureter at the same time. (Lymph nodes act as filters in your body).
This operation is carried out under a general anaesthetic. This means you will be asleep throughout.
We will give you more information about the anaesthetic at your pre-operative assessment appointment.
About robot-assisted surgery
We perform this operation using keyhole (laparoscopic) surgery with robotic assistance.
Keyhole surgery means we insert a telescope and other instruments into your body through small cuts (instead of one large cut).
Robot-assisted surgery means the surgeon uses the robot to help perform the procedure. The robot does not operate by itself. It allows the surgeon to make more precise movements and do more complex surgery.
Read our leaflet to learn more about robot-assisted surgery and why we use a robot.
Benefits of this type of surgery
Traditional surgery to remove a kidney needs the surgeon to make a cut in the abdomen up to 30cm long. Keyhole surgery uses only a few small cuts (each about the size of your fingertip). Sometimes we may need to make a larger cut, depending on the situation.
This means that robot-assisted keyhole surgery has many benefits, compared to traditional ‘open’ surgery.
Most patients go home the day after surgery, or within 1 to 3 days.
You are likely to return to normal activities sooner after keyhole surgery.
Other benefits of keyhole surgery include:
- smaller scars
- less blood loss
- lower risk of infection
- less pain
- lower risk of wound complications, such as urine leakage.
What to expect
Before your operation
Before your surgery, you will have the following.
- An appointment with the surgical doctors. They will explain the procedure and discuss the benefits and risks.
- A pre-operative assessment. This may include blood tests, heart checks and other tests. At this assessment, we will give you full instructions on how to prepare in the days leading up to your operation. These include whether to stop your medications, and when to stop food and drink. If you have other relevant medical conditions, you may see a consultant anaesthetist for more detailed checks.
On the day of surgery
On the day of surgery, we will admit you to the Kingston Hospital Admissions on the Day (AOD) Unit. If you have other health problems we may admit you the evening before surgery.
The anaesthetist will see you on the morning of surgery. The surgical team will also see you to obtain your consent for surgery. They will draw a mark on the side of your body where the surgery will take place.
We may decide to give you a spinal anaesthetic before we give you a general anaesthetic. This will make you numb (have no feeling) from the waist down during the operation. This lack of feeling will continue for 6 to 12 hours, and will help with your post-operative pain levels.
After the operation (in hospital)
After surgery, you may spend one night in a high-dependency unit, if needed.
We may give you:
- an oxygen tube in your nose (which we usually take out after 1 day)
- a morphine machine to control your pain (which we usually take out after 1 day)
- a drip in your arm (which we usually take out after 1 day)
- a wound drain to remove excess blood and fluid (which we usually take out after 1 to 2 days)
- a catheter (thin, flexible tube) to drain your bladder (which we usually take out after 1 to 2 days).
Driving
You will not be able to drive yourself home after this procedure. We advise you to arrange for someone to drive you home and stay with you overnight.
Blood test and blood thinners
Before we discharge you, we may test your blood to check your kidney function.
If we have taken out your lymph nodes (see Removal of a kidney and the ureter, above), we will send you home with a 28-day supply of blood-thinner injections. These will help to reduce your risk of blood clots. We will show you how to inject yourself before you leave hospital.
Eating and drinking
We will give you instructions about eating and drinking after your surgery. It is likely we will encourage you to drink and eat as you feel able.
Pain
You may feel mild pain, swelling or bruising around the surgery cuts.
You may get shoulder pain, due to the gas we use to inflate your abdomen during surgery. Your abdomen may feel bloated (swollen) or uncomfortable. These symptoms usually settle within a few days.
Getting moving
Our nurses or physiotherapists will help you to get out of bed and move around. If you can, do this first thing on the morning after your surgery. Gentle movement helps reduce complications and will speed up your recovery.
Going home
Most patients go home 1 to 3 days after surgery, depending on their recovery.
You may have stitches that dissolve (fall out naturally) or wound clips. If you have wound clips, you will need to arrange for your GP practice nurse to remove them 10 to 14 days after surgery.
Do not drive for 2 to 4 weeks after your operation. Only drive when you are not limited by pain and can react quickly enough to perform an emergency stop.
Recovery at home
You can expect the following while you recover at home.
| Pain | For most patients, their pain is often at its worst between day 2 and day 4 after the operation. Before you leave hospital, we will discuss appropriate pain relief with you. |
| Washing | You can shower on the day after your operation. Your surgery wounds will not need dressings. |
| Constipation | Patients often feel constipated (unable to poo easily). We will give you medicines (laxatives) to use if you need them. |
| Tiredness | You may feel tired for up to 2 months. This is normal. |
| Exercise |
We recommend gentle walking and light exercise. This will speed up your recovery. For 3 to 4 weeks, avoid heavy lifting, gym work, running, cycling or swimming. |
| Check your wounds |
Check your wounds for signs of infection, such as redness, swelling, pain or discharge. Contact your GP, district nurse or hospital team if you have any concerns. |
When to seek urgent medical help
Go to your nearest Emergency Department (A&E) if you experience:
- blood in your urine 1 or 2 weeks after, and the blood does not go away if you drink lots of fluids (6 to 8 glasses of water a day)
- fevers or sweating
- vomiting
- a feeling of being extremely unwell (you feel something is seriously wrong with your health).
Risks of this operation
Risks during or shortly after surgery
| More common More than 15 in 300 patients |
|
| Less common Fewer than 15 in 300 patients |
|
| Rare Fewer than 3 in 300 |
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Risks after surgery
| Common More than 15 in 300 patients |
|
| Less common Fewer than 15 in 300 patients |
|
| Rare Fewer than 3 in 300 |
|
Follow-up
We will invite you for a follow-up appointment 2 to 4 weeks after your procedure.
More information
Contact information
Kingston Hospital Urology Department