Nephrectomy with Total Ureterectomy and Bladder Cuff; Through Same Incision

Name of the Procedure:

• Common Name: Nephroureterectomy
• Technical Terms: Nephrectomy with Total Ureterectomy and Bladder Cuff Excision

Summary:

Nephrectomy with total ureterectomy and bladder cuff removal is a surgical procedure that removes a kidney, its associated ureter, and a small portion of the bladder through a single surgical incision. This operation is typically done to treat certain cancers of the kidney and ureter.

Purpose:

• Medical Condition: Treat cancer or severe disease of the kidney and ureter.
• Goals/Outcomes: Remove the diseased or cancerous kidney and ureter in order to prevent the spread or recurrence of disease.

Indications:

• Symptoms: Blood in the urine (hematuria), flank pain, recurrent urinary tract infections.
• Conditions: Kidney cancer, transitional cell carcinoma of the ureter.
• Patient Criteria: Suitable for patients with localized disease confined to one kidney and ureter.

Preparation:

• Pre-procedure Instructions: Fast for at least 8 hours prior, adjust medications as directed by the physician, stop blood thinners if instructed.
• Diagnostic Tests: Blood tests, imaging studies such as CT scans or MRIs, and possibly a cystoscopy.

Procedure Description:

1. Anesthesia: General anesthesia is administered to ensure the patient is completely unconscious and pain-free.
2. Incision: A single incision is made in the abdomen or flank.
3. Kidney Removal: The surgeon carefully dissects and removes the kidney.
4. Ureter Removal: The entire ureter up to its insertion in the bladder is excised.
5. Bladder Cuff Excision: A small portion of the bladder cuff where the ureter inserts is also removed.
6. Closure: The incision is closed with sutures or staples, and a drainage tube may be placed to prevent fluid accumulation.

Duration:

The procedure typically takes 3-4 hours.

Setting:

Performed in a hospital operating room.

Personnel:

• Surgeon (urologist)
• Anesthesiologist
• Surgical nurses
• Surgical assistants

Risks and Complications:

• Common Risks: Infection, bleeding, pain.
• Rare Complications: Blood clots, injury to surrounding organs, extended hospital stay due to complications, urinary leakage.

Benefits:

• Expected Benefits: Reduction or elimination of cancer or diseased tissue, potential cure or significant extension of survival.
• Realization Time: Recovery of normal function might begin within weeks, but cancer benefits are usually assessed over months to years.

Recovery:

• Post-procedure Care: Pain management with medications, instructions on incision care, possible placement of a urinary catheter.
• Recovery Time: Typically 4-6 weeks. Patients may face restrictions on heavy lifting and strenuous activities. Follow-up appointments are essential to monitor recovery and disease status.

Alternatives:

• Other Options: Partial nephrectomy, kidney-sparing surgery, targeted therapy, radiation therapy.
• Pros and Cons: Non-surgical alternatives might have fewer risks but may not be as effective in removing all cancerous tissues.

Patient Experience:

• During the Procedure: The patient is under general anesthesia and will not be aware or feel anything.
• Post-procedure: Expect initial discomfort and pain managed with medications, potential mild blood in urine, restricted physical activity, and a gradual return to normalcy over several weeks.