NEPHRECTOMY (RADICAL OR SIMPLE REMOVAL OF KIDNEY)

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1 NEPHRECTOMY (RADICAL OR SIMPLE REMOVAL OF KIDNEY) Patient Information Leaflet Your Health. Our Priority.

2 Page 2 of 7 What is a Nephrectomy? Most people have two kidneys, one at each side at the back of the abdomen. They filter the blood in your body to remove waste products, which are passed out of the body in your urine. Urine is carried by a tubes (ureters) leading from each kidney to the bladder. When the bladder is full, urine passes out of your body through a tube called the urethra. A simple nephrectomy involves removing the whole of one kidney. A radical nephrectomy is the removal of one kidney and the surrounding tissues, which include; The adrenal gland, which is attached to the kidney. Some lymph nodes situated near the kidney. In some cases the ureter is also removed(this would be called a nephroureterectomy) In order to get to the kidney, the Urological Surgeon will usually make a cut (incision) between the lower ribs on the same side as the affected kidney. Part of a rib may be removed, to make it easier to remove the kidney. The operation is carried out under a general anaesthetic (when you are asleep) and usually requires a stay in hospital of about 5-7 days. What are the Benefits Nephrectomy can be carried out; Because a kidney is damaged and not working properly. In order to donate a kidney. Chronic infection. Injury to the kidney Kidney stones Because you have cancer in your kidney The aim of the operation is to remove the kidney, which is affecting your health. If cancer is present, the aim is to remove all the cancer, so that the extent of the disease can be assessed, this is called staging and will help the urology doctors decide if you need further treatment. What to expect after the operation/some of the complications post op Pain The ward staff will give you painkillers to control any pain you may have. This may be in the form of a device that you use to control your pain yourself. This is known as a patient controlled analgesia (PCA) and you will be shown exactly how to use it Pain relief may also be administered by the nursing staff. Bleeding A blood transfusion may be needed to replace blood lost during the operation. Very occasionally, there may be internal bleeding after the operation making further surgery necessary. Bruising or infection in the wound If your wound appears very reddened and/or has a discharge (pus), you may require antibiotics. Blood clots in the leg (deep vein thrombosis/dvt) - As you are not able to move around immediately after the operation, blood clots may form in your leg, which can occasionally lead to a clot in the lungs (pulmonary embolus/pe). Moving around as soon as possible after your operation can help to prevent this and you may be given special surgical stockings to

3 Page 3 of 7 wear whilst you are in hospital and possibly injections to thin the blood. You may also be shown how to perform leg exercises, to prevent blood clots occurring. Chest infection This is due to the effects of the anaesthetic and you may be taught deep breathing exercises by a physiotherapist, which you should do regularly after your operation, to help prevent a chest infection. Pneumothorax (collapsed lung) - This is rare but can happen because a cut is close to the ribs. If this occurs, you may need a drain (tube) in your chest until your lung recovers. Possible need for further treatment If cancer is present in the kidney and the surgeon is unable to remove it completely, further treatment may be necessary. Renal dialysis (a procedure to remove waste products from the blood) - In most cases you will still have one kidney, which will continue to work. However, some patients who need complex surgery may need renal dialysis. What are the Alternatives You may choose to do nothing, although your health is likely to deteriorate. If cancer is present, this will progress. You may wish for your care to be transferred to the palliative care team, whose aim is to improve quality of life, rather than saving lives. If this is the case, please let us know. How Long Will I Be In Hospital For? Patients usually stay in hospital for approximately 5-8 days after a nephrectomy but no 2 patients are the same. This will depend on how well you progress following your operation. What Happens to me when I arrive on the Ward? You will usually come into hospital on the day of your operation. You will meet the nursing staff who will be looking after you and an anaesthetist, who will discuss your options for pain relief following the operation and also talk to you about the anaesthetic you will have. On The Day of the Procedure You will have nothing to eat or drink for several hours before the operation. If you would normally take tablets during this time, you will be informed at the pre-operative assessment clinic which you should continue to take. Before going to the operating theatre, you may be asked to take a bath or shower and change into a theatre gown. Any make-up, nail varnish, jewellery (except your wedding ring), dentures and contact lenses must be removed. You may be given some tablets as part of the preparation for your anaesthetic, known as a "pre-med". These will help you feel more relaxed. What Happens After The Procedure? When you come out of theatre, you will be transferred to the recovery area before you are taken back to your ward. You may still be very sleepy at first and will be given oxygen through a face mask. If you require close monitoring, you may be nursed in the High Dependency Unit (HDU) until you are ready to return to the main ward.

4 Page 4 of 7 The ward staff will give you painkillers to control your pain. You will have a drip running into a vein to give you fluids until you are able to drink normally, which is usually the day following the operation. You will gradually increase your fluid and food intake over the next few days and the drip will then be removed. You will have a catheter (tube into the urethra draining urine from the bladder), so that the amount of urine that you pass can be measured. This will be removed when you are more mobile. You will be encouraged to breath deeply after your operation and move your legs in bed. The nursing staff will help you to get out of bed on the 1 st and 2 nd day after the operation and help you to start walking soon after this. You are normally up and about independently about 2-3 days after surgery. Discharge Arrangements You will normally be ready to go home about 5-7 days following the operation. You will be required to arrange for a responsible adult to collect you from hospital. Arrangements will be made for a District Nurse to visit you at home to remove your stitches about 10 days after the operation. You will be given 7 days supply of any medications you have been prescribed and a letter will be sent to your GP informing them of your treatment and progress. An outpatient appointment will be arranged for you to be seen in your local urology department about 6-8 weeks after the operation. The results of your surgery will be discussed with you, as well as any further treatment that may be necessary. Day to Day Living Recovery time after this type of surgery varies, but generally you should feel improvements from between 2-3 weeks. This may take longer if your surgery has been more complex. The wound can take up to 8 weeks to heal fully and the scar on your side should fade with time. During the first 6 weeks, you should not drive and we advise that you contact your car insurers for advice on driving following this procedure. Going back to work will depend on the type of job that you do and how you feel. This may be between 2 and 3 months and your GP can provide you with a sick note for the time you are off work. You should not lift heavy objects or do anything that might put a strain on your wound including strenuous exercise, for around 6 weeks after the operation. Drinking plenty of fluids and passing urine regularly, will help keep your remaining kidney healthy. If There is a Problem If you experience any problems following discharge from hospital, please contact your GP for advice. Please replace this paragraph with your department s contact details. You should supply a variety of contact options. For example, a telephone number and an address or fax number. You should also encourage the patient to contact the department if they have any assistance needs. This should also highlight the option to use the sighted guides from main reception.

5 Page 5 of 7 Contact Us Department of Urology Stockport Tel: Website: Tameside Tel: /6696 Website: Macclesfield Tel: Other Useful Contacts or Information It is important that you have as much information as you would like before you agree to have this operation. If you have any questions about your treatment, do not be afraid to ask your doctor or specialist nurse. You may be feeling a wide range of emotions and for some people undergoing surgery can be a frightening and unsettling time. It may help you to talk about how you are feeling to someone who specialises in dealing with this condition, such as your Urologist or the Urology Specialist Nurse. They will listen, answer any questions you may have, or can put you in touch with other professionals or support agencies if you wish. Some useful contact numbers are listed below. Macmillan Cancer Support 89 Albert Embankment London SE1 7UQ (provides specialist advice through Macmillan nurses, doctors and financial grants for people with cancer and their families.) Cancer Backup Bath Place Rivington Street London EC2A 3JR (freephone information line, Mon-Fri 9am to 7 pm) (provides information on all aspects of cancer and its treatment and on practical and emotional problems of living with cancer) Greater Manchester and Cheshire NHS Cancer Network website

6 Page 6 of 7 (Website with information about all aspects of cancer and details of support for people affected by cancer). Kidney Cancer UK Administration Office PO Box 2473 Uttoxeter Staffordshire ST14 8WZ Source of Good Practise Greater Manchester and Cheshire NHS Cancer Network website (Website with information about all aspects of cancer and details of support for people affected by cancer).

7 Page 7 of 7 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number Uro45 Publication date October 2012 Review date October 2014 Department Urology Location Stepping Hill Hospital, Tameside and Macclesfield