Name of the Procedure:

Nephrectomy with Total Ureterectomy and Bladder Cuff Removal; Through Separate Incision

Summary

A nephrectomy with total ureterectomy and bladder cuff removal is a surgical procedure where the entire kidney, ureter, and a small portion of the bladder are removed. This is done through separate incisions to ensure thorough removal of the diseased segments.

Purpose

This procedure addresses significant kidney disease, cancer, or chronic infection. The goal is to remove the diseased kidney and ureter to prevent the spread of disease and improve patient health.

Indications

• Kidney cancer or tumors
• Chronic or severe kidney infections
• Ureteral cancer
• Non-functioning kidney due to chronic disease
• Persistent swelling or blockage of the ureter

Preparation

• Fasting for at least 8 hours prior to surgery
• Medication adjustments as directed by the healthcare provider
• Preoperative blood tests, imaging studies (CT scans, MRIs), and possible cardiac evaluations

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen or side to access the kidney.
3. The kidney is carefully detached from surrounding tissues and blood vessels.
4. A second incision is made to remove the ureter and a portion of the bladder cuff where the ureter meets the bladder.
5. Removal of the kidney, ureter, and bladder cuff occurs in separate steps to ensure all diseased tissue is excised.
6. Incisions are closed with sutures or staples, and sterile dressings are applied.

Tools and equipment: Surgical scalpel, retractors, clamps, sutures, and possibly laparoscopic instruments if a minimally invasive approach is used.

Duration

The procedure typically takes 3 to 4 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses and assistants
• Possibly a urologist or oncologist

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Injury to surrounding organs or tissues
• Pain at the incision site
• Hernia
• Long-term complications like kidney function reduction

Benefits

• Reduces or eliminates cancer spread
• Removes source of chronic pain or infection
• Potentially life-saving in cases of cancer
• Improved quality of life post-recovery

Recovery

• Hospital stay of 5 to 7 days
• Pain management with medications
• Avoid heavy lifting and strenuous activities for 6 to 8 weeks
• Follow-up appointments for wound inspection and overall health monitoring
• Gradual return to normal activities based on surgeon’s advice

Alternatives

• Partial nephrectomy (only part of the kidney removed)
• Radiation therapy for cancer
• Chemotherapy, if necessary
• Ablation techniques for specific cancers
• Watchful waiting in non-aggressive cases

Patient Experience

During the procedure, the patient is under general anesthesia and thus will not feel pain. Postoperatively, pain and discomfort are managed with medication. The patient may experience soreness at the incision sites and may need assistance with daily activities initially. Full recovery can take several weeks, with gradual improvement in symptoms and activity level.