NEPHRECTOMY NEPHROURETERECTOMY

Nephrectomy and nephroureterectomy - Indications :
- renal cell cancer
- non-functioning kidney containing a staghorn calculus
- persistent haemorrhage following renal trauma

Anaesthesia :
General

Post-operative care :
Nephrectomy :
Cardiovascular status and urine output should be carefully monitored in the immediate post-operative period. Haemorrhage from the renal pedicle or, for left-sided nephrectomy, the spleen, is rare, but will present with an increasing tachycardia, cool peripheries, falling urine output, and eventually a drop in blood pressure. A drain is usually not left in place, but if it is there may be excessive drainage of blood from the drain. However, do not be lulled into a false sense of security by the absence of drainage this does not mean that haemorrhage is not occurring, as the drain may be blocked but haemorrhage may be ongoing.
For nephrectomy via a posterolateral (rib-based) incision, watch for pneumothorax. Arrange a CXR on return from the recovery room. Arrange routine chest physiotherapy to reduce the risk of chest infection. Regular chest examination is important, looking specifically for pneumothorax and pleural effusion.
Mobilize the patient as quickly as possible, to reduce the risk of DVT and PE.

Nephroureterectomy ::
Where the ureter has been excised from the bladder, a urethral catheter is left in place at the end of the procedure, to allow the hole in the bladder to heal. This is usually removed 10 14 days after surgery.

Common post-operative complications and their management
- Haemorrhage see above.
- Wound infection rare. If superficial, treat with antibiotics. If an underlying collection of pus is suspected, open the wound to allow free drainage, and pack the wound daily.
- Pancreatic injury is rare, but would be indicated by excessive drainage of fluid from the drain, if present, which will have a high amylase level. If no drain is present, an abdominal collection will develop, which may be manifested by a prolonged ileus.