Laparoscopic Nephroureterectomy

Laparoscopic nephroureterectomy is surgery to remove a kidney and ureter. You may need this surgery for cancer in or injury to a kidney or ureter. Your two kidneys are organs that filter your blood, remove waste chemicals and extra water to make urine. Ureters are tubes that carry urine from your kidneys to your bladder.

For the surgery, the surgeon uses a tool called a laparoscope (scope). This is a thin, lighted tube with a camera on the end. The scope lets the surgeon work through a few small cuts (incisions).

In most cases, after surgery your body can still work well with only one healthy kidney and ureter.

Getting ready for surgery

Follow any instructions from your healthcare provider.

Tell your provider about any medicines you are taking. You may need to stop taking all or some of these before the test. These include:

• All prescription medicines
• Blood-thinning medicines (anticoagulants) or aspirin
• Over-the-counter medicines such ibuprofen (Motrin/Advil) or acetaminophen (Tylenol)
• Street drugs
• Herbs, vitamins and other supplements

In addition:

• Do not eat or drink during the 8 hours before your surgery or as directed by your healthcare provider. This includes coffee, water, gum, and mints.
• If your healthcare provider tells you to take medicines, take them with a small sip of water.
• If your healthcare provider tells you, prepare your bowel ready for surgery one to 2 days before the surgery. You may need to limit your diet to only clear liquids. You may also be asked to take laxatives or to give yourself an enema. Follow your healthcare provider’s instructions.

The day of surgery

The surgery usually takes 3 to 5 hours. After surgery, you will stay in the hospital for 1 to 3 nights.

Before the surgery begins

• An intravenous (IV) line is put into a vein in your arm or hand to supply fluids and medicines such as antibiotics.
• You may be given medicine to prevent blood clots.
• To put you to sleep and to keep you free of pain during the surgery, you will be given general anesthesia. This medicine puts you into a state like a deep sleep through the surgery. A tube may be put into your throat to help you breathe.

During the surgery

• The provider makes a few small incisions and one slightly larger incision in your belly (abdomen).
• The provider puts the scope through an incision. The scope then sends live pictures of the inside of your abdomen to a video screen.
• The provider fills your abdomen with gas making space for the provider to see and work.
• Using tools placed through the incisions, the provider gets the kidney and ureter ready for removal. The provider detaches the small piece of tissue where the ureter connects to the bladder (bladder cuff).
• The provider removes the kidney, ureter, and bladder cuff through the larger incision. Nearby lymph nodes may be removed as well.
• When the surgery is complete, the provider removes all of the tools then closes the incisions with stitches or staples.
• The provider puts a thin tube (Foley catheter) in your bladder. This will drain your urine while your bladder heals.
• The provider will begin with laparoscopy but he or she may need to change to open surgery for safety reasons.
• Open surgery is done using an incision in your abdomen or side. You will be told more about this possibility before surgery.

Recovering in the hospital

• After the surgery, you will be taken to a post anesthesia care unit (PACU). There, you will wake up from the anesthesia.
• You may feel sleepy and may have an upset stomach (nausea).
• If a breathing tube was used, your throat may be sore at first.
• When you are ready, you will be taken to your hospital room.

While in the hospital:

• You will be given medicines to manage your pain. Let your provider know if your pain is not going away.
• You will first get IV fluids and in a day or so, you will start on a liquid diet. You will then slowly return to a normal diet.
• You will be taught ways to cough and breathe to help keep your lungs clear and prevent pneumonia.
• The healthcare team may remove the Foley catheter while you are in the hospital. If not, you will be taught how to care for it at home.

Recovering at home

• After your hospital stay, if possible, have someone stay with you for the next few days to help care for you.
• Recovery time varies for each person. Your provider will tell you when you can return to your normal routine. 
• Until then, follow the instructions you have been given.

Make sure to:

• Take all medicines as directed.
• Care for your incisions and catheter as instructed.
• Follow your provider’s guidelines for showering. Do not swim, bathe, use a hot tub, or do other activities that cover the incision with water until your provider says it is okay.
• Do not lift anything heavy or do strenuous activities, as directed by your provider.
• Do not drive until your provider says it’s okay. Do not drive if you are taking medicines that make you drowsy or sleepy.
• Walk at least a few times a day, gradually increasing your pace and distance.
• Do not strain to pass stool. If needed, take stool softeners as directed by your provider.
• Drink plenty of water. This helps prevent urine odor and dehydration.
• Follow any other diet instructions you are given. For instance, you may be told to limit the amount of salty foods you eat.
• You may also need to avoid drinking alcohol.

Follow-up

• You will have follow-up visits so your healthcare provider can check how well you are healing.
• If your stitches, staples, or catheter need to be removed, this will likely be done in 7 days.
• If you have had the surgery due to cancer, you may need tests to make sure the cancer has not returned.