Nephrectomy Surgery: Procedure, Types, and Recovery Explained

Nephrectomy surgery removes part or all of a kidney. Doctors usually recommend this operation only when a serious condition damages the kidney or threatens the patient’s health.

Depending on the condition, the surgeon may remove only the affected section. In other cases, the surgeon may need to remove the entire kidney.

Why Is Nephrectomy Surgery Needed?

A doctor may recommend nephrectomy surgery for several reasons. The final decision depends on kidney function, test results and the patient’s general health.

1. Kidney Cancer

Kidney cancer is a common reason for nephrectomy surgery. The surgeon may remove the tumour and a small amount of nearby healthy tissue.

However, larger or more complex tumours may require removal of the entire kidney. The doctor selects the procedure after reviewing scans and other test results.

2. Severely Damaged Kidney

A kidney may lose most or all of its function because of stones, blockage, injury or another disease. If the damaged kidney causes ongoing problems, the doctor may recommend removal.

3. Repeated Kidney Infections

A poorly functioning kidney may cause repeated or serious infections. In selected cases, removing that kidney can help control the problem.

4. Difficult-to-Control High Blood Pressure

Rarely, a severely damaged kidney may contribute to high blood pressure. The doctor may consider nephrectomy when other treatments do not control the condition.

5. Kidney Abnormalities Present from Birth

Some people are born with an abnormal kidney. Surgery may become necessary if the kidney causes pain, infection, blockage or other health problems.

6. Living Kidney Donation

A healthy person may choose to donate one kidney to someone who needs a transplant. Doctors perform detailed tests before approving a living kidney donor.

7. Severe Kidney Injury

A serious accident or injury can badly damage a kidney. Doctors try to preserve the kidney when possible. However, severe bleeding or damage may require removal.

Types of Nephrectomy Surgery

There are two main types of nephrectomy. The surgeon chooses the most suitable type according to the patient’s condition.

Partial Nephrectomy

During a partial nephrectomy, the surgeon removes the tumour or damaged area. The surgeon preserves the healthy part of the kidney whenever possible.

This method can help maintain kidney function. Therefore, doctors may prefer it for suitable small kidney tumours.

Radical Nephrectomy

During a radical nephrectomy, the surgeon removes the entire kidney. The surgeon may also remove nearby fatty tissue or other structures when medically necessary.

However, the surgeon does not remove the adrenal gland in every case. The treatment plan depends on the disease and its location.

Approaches to Nephrectomy Surgery

Surgeons can perform nephrectomy through open, laparoscopic or robot-assisted surgery. Each approach has different advantages and limitations.

Laparoscopic Nephrectomy

The surgeon makes several small cuts in the abdomen or side. The surgeon then inserts a camera and special instruments through these openings.

Carbon dioxide gas gently creates working space inside the abdomen. As a result, the surgeon can see and reach the kidney more clearly.

Robot-Assisted Nephrectomy

Robot-assisted surgery also uses small cuts. However, the surgeon controls robotic instruments from a nearby console.

This system can support careful movement during complex surgery. Nevertheless, the surgeon remains in full control throughout the operation.

Open Nephrectomy

During open surgery, the surgeon makes one larger incision. This approach may help with large tumours, severe injuries or complex conditions.

Open nephrectomy usually requires a longer recovery. Even so, it may provide the safest option for certain patients.

Nephrectomy Surgery: Step-by-Step Procedure

1. Preoperative Preparation

First, the medical team reviews the patient’s health and treatment plan. The doctor may request blood tests, urine tests and imaging scans.

A CT scan or MRI can show the kidney and nearby organs. These images help the surgeon plan the operation.

Patients should tell the doctor about all medicines and supplements they take. In particular, they should mention blood-thinning medicines.

The hospital also provides fasting instructions. Patients must follow these directions carefully before surgery.

2. General Anaesthesia

The anaesthesia team gives general anaesthesia before the operation. This medicine keeps the patient asleep during surgery.

The team also supports breathing and checks the patient’s vital signs. These include heart rate, oxygen level and blood pressure.

3. Patient Positioning

The surgical team places the patient in a suitable position. Often, the patient lies on one side to provide access to the kidney.

However, the exact position may vary. The team then cleans and prepares the surgical area.

4. Surgical Access

For laparoscopic or robot-assisted surgery, the surgeon makes several small cuts. The surgeon passes a camera and instruments through these openings.

For open surgery, the surgeon makes a larger cut in the abdomen or side. The surgeon chooses the location according to the planned operation.

5. Separating the Kidney

Next, the surgeon carefully separates the kidney from nearby tissue. The surgeon also identifies the kidney’s main blood vessels and the ureter.

The renal artery carries blood to the kidney. Meanwhile, the renal vein carries blood away from it.

The surgeon safely controls and divides these blood vessels. The surgeon also divides the ureter when removing the entire kidney.

6. Removing the Kidney or Tumour

During partial nephrectomy, the surgeon removes only the tumour or damaged section. Afterwards, the surgeon repairs the remaining kidney.

During radical nephrectomy, the surgeon removes the whole kidney. The surgeon may remove additional nearby tissue if the condition requires it.

In minimally invasive surgery, the surgeon places the specimen in a protective bag. The surgeon then removes it through one of the incisions.

7. Closing the Incisions

The surgeon checks the area for bleeding before completing the operation. If necessary, the surgeon places a temporary drain.

Finally, the surgeon closes the incisions with stitches, staples or surgical glue. The team then covers the area with a sterile dressing.

Recovery After Nephrectomy Surgery

After surgery, the medical team moves the patient to a recovery area. Staff check breathing, blood pressure, pain and urine output.

The patient may receive fluids and pain medicine. A urinary catheter may also remain in place for a short time.

At first, the patient may receive liquids. Afterwards, the medical team gradually adds normal food.

Early movement can help reduce certain recovery risks. Therefore, staff usually encourage gentle walking when it becomes safe.

Hospital Stay

The length of the hospital stay varies. Patients who undergo minimally invasive surgery may leave sooner than patients who undergo open surgery.

However, the patient’s health and recovery progress determine the discharge date. The surgeon will decide when the patient can safely return home.

Recovery at Home

Patients should keep the wound clean and follow all medicine instructions. They should also avoid heavy lifting until the surgeon gives permission.

Recovery may take several weeks. However, each person heals at a different rate.

Living With One Kidney

Many people can live an active life with one healthy kidney. The remaining kidney often performs the work needed by the body.

However, regular health checks remain important. The doctor may monitor kidney function, urine protein and blood pressure.

Patients should also follow medical advice about food, fluids, exercise and medicines. These steps can help protect the remaining kidney.

Possible Risks

Like every major operation, nephrectomy surgery has possible risks. These may include:

• Bleeding
• Infection
• Blood clots
• Reaction to anaesthesia
• Injury to a nearby organ
• Temporary or long-term kidney function problems
• Pain or wound complications

The surgeon should explain the personal benefits and risks before the operation.

Conclusion

Nephrectomy surgery removes part or all of a kidney. Doctors may recommend it for cancer, severe kidney damage, repeated infection or living kidney donation.

The surgeon may use open, laparoscopic or robot-assisted surgery. The choice depends on the condition and the patient’s health.

Patients should discuss the procedure and recovery plan with a qualified urologist. The doctor can provide guidance based on the individual diagnosis.

This article provides general educational information. It does not replace professional medical advice, diagnosis or treatment.

Kidney stones can cause severe pain and affect urine flow. Small stones may pass naturally. However, larger stones sometimes require medical treatment or kidney stone surgery.

Urology focuses on the urinary system, including the kidneys, ureters, bladder and urethra. A urologist diagnoses and treats kidney stones and other urinary conditions.

This guide explains why patients may need treatment. It also describes what happens before, during and after common kidney stone procedures.

What Are Kidney Stones?

Kidney stones are hard deposits that form from substances in urine. They can develop in one or both kidneys.

Stone size can range from a tiny grain to a much larger mass. In addition, stones can have different shapes and chemical compositions.

Small stones may leave the body through urine. In contrast, larger stones can become trapped in the kidney or ureter.

Why Do Kidney Stones Require Surgery?

Not every kidney stone requires surgery. The urologist considers the stone’s size, location and effect on the urinary system.

A doctor may recommend a procedure when:

• The stone causes severe or ongoing pain
• The stone blocks the flow of urine
• The patient develops a urinary infection
• The stone affects kidney function
• The stone is unlikely to pass naturally
• Other treatments do not work
• Stones continue to return
• The patient experiences persistent bleeding

Therefore, the best treatment differs from one patient to another. A urologist will review the available options before making a recommendation.

Tests Before Kidney Stone Surgery

Before treatment, the doctor needs to identify the stone’s size and location. The doctor may also investigate its possible cause.

Imaging Tests

A CT scan, ultrasound or X-ray can show the urinary tract. These tests help the doctor locate the stone and plan treatment.

Blood Tests

Blood tests can check kidney function and look for other health concerns. In addition, they may measure substances linked with stone formation.

Urine Tests

A urine test can identify blood, crystals or signs of infection. If the patient has an infection, the doctor may treat it before surgery.

Medical Evaluation

The medical team reviews the patient’s health, medicines and allergies. Patients should mention blood-thinning medicines and any previous reaction to anaesthesia.

Common Types of Kidney Stone Surgery

Urologists use several methods to treat kidney stones. The doctor chooses a procedure based on the stone and the patient’s health.

1. Shock Wave Lithotripsy

Shock wave lithotripsy uses focused shock waves to break a stone into smaller pieces. Patients can then pass these pieces through urine.

This treatment does not require an incision. However, it may not suit every stone size, location or type.

What Happens During Shock Wave Lithotripsy?

First, the medical team positions the patient on a treatment table. The doctor then uses imaging to locate the stone.

Next, the machine sends shock waves towards the stone. These waves break the stone into smaller fragments.

Afterwards, the patient may pass fragments for several days or weeks. The doctor may also recommend follow-up imaging.

2. Ureteroscopy

Ureteroscopy allows the doctor to reach a stone through the natural urinary passage. Therefore, the procedure does not require an external incision.

The surgeon passes a thin ureteroscope through the urethra and bladder. The instrument then enters the ureter or kidney.

What Happens During Ureteroscopy?

First, the anaesthesia team helps keep the patient comfortable. Next, the surgeon guides the ureteroscope towards the stone.

The surgeon may remove a small stone with a basket. Alternatively, laser energy can break a larger stone into smaller pieces.

Sometimes, the surgeon places a temporary ureteral stent. The stent supports urine flow while the ureter heals.

3. Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy, or PCNL, treats large or complex kidney stones. It can also treat branching stones called staghorn stones.

During PCNL, the surgeon reaches the kidney through a small opening in the back or side. General anaesthesia keeps the patient asleep during the procedure.

What Happens During PCNL?

First, the surgeon uses imaging to select an access route. The surgeon then passes a needle and guidewire into the kidney.

Next, the surgeon widens the track and inserts a working sheath. A nephroscope passes through this sheath and displays the kidney’s interior.

The surgeon breaks the stone with specialised energy and removes the fragments. Finally, the surgeon may place a drainage tube or ureteral stent.

4. Open or Laparoscopic Stone Surgery

Doctors rarely use open surgery for kidney stones today. Modern endoscopic methods can treat most stones with smaller incisions.

However, open, laparoscopic or robotic surgery may help in unusual or highly complex cases. The surgeon may also consider these options when other treatments cannot solve the problem.

What Happens During Open Surgery?

The surgeon makes an incision to reach the kidney or ureter. The surgeon then removes the stone and closes the incision.

This approach usually requires a longer hospital stay and recovery. Therefore, doctors reserve it for selected patients.

What Happens on the Day of Surgery?

The hospital will provide instructions about eating, drinking and medicines. Patients should follow these instructions carefully.

Before the procedure, the medical team checks the patient’s identity and treatment plan. The anaesthesia team also explains the planned anaesthesia.

During treatment, the team monitors breathing, heart rate and blood pressure. After the procedure, staff move the patient to a recovery area.

Recovery After Kidney Stone Surgery

Recovery depends on the type of procedure. Shock wave treatment and ureteroscopy often allow faster recovery than PCNL or open surgery.

After treatment, patients may experience mild pain, frequent urination or temporary blood in the urine. A ureteral stent can also cause discomfort.

The doctor may prescribe pain medicine or antibiotics. In addition, the doctor may recommend drinking enough water when medically suitable.

Patients should avoid heavy lifting until the doctor approves it. They should also attend all follow-up appointments.

Possible Risks of Stone Surgery

Kidney stone procedures are common, but they still carry possible risks. These risks depend on the selected treatment.

Possible complications include:

• Bleeding
• Urinary infection
• Pain or swelling
• Injury to the urinary tract
• Remaining stone fragments
• Urinary blockage
• Need for another procedure
• Reaction to anaesthesia

The urologist should explain the expected benefits and personal risks before treatment.

When Should You Contact the Doctor?

Patients should seek medical advice if they develop severe or unusual symptoms. Warning signs may include:

• Fever or chills
• Severe or increasing pain
• Heavy bleeding or large blood clots
• Difficulty passing urine
• Persistent vomiting
• Signs of infection

How Can You Reduce the Risk of New Stones?

Kidney stones can return after treatment. Therefore, prevention forms an important part of follow-up care.

The doctor may analyse the removed stone. The doctor may also request blood tests or a 24-hour urine test.

Based on the results, the doctor may recommend more fluids, dietary changes or medicine. However, patients should follow personalised advice because stone types differ.

Conclusion

Kidney stone surgery can remove or break stones that cannot pass naturally. Urologists may use shock wave treatment, ureteroscopy, PCNL or another method.

Each procedure has different benefits, risks and recovery times. Therefore, patients should discuss their treatment options with a qualified urologist.

Understanding the process can help patients prepare for treatment. It can also help them follow recovery and prevention advice.

This article provides general educational information. It does not replace professional medical advice, diagnosis or treatment.

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