The most common form of renal surgery is partial or complete removal of the kidneys (nephrectomy). Renal cell carcinoma, chronic inflammation of the kidneys, malformations or serious cases of kidney stones are possible reasons for renal surgery. Surgery on the ureter is required in the case of cancer of the ureter, ureteral stenosis or to remove kidney stones.

Renal cancer, malformations of the kidney, renal infarction and chronic inflammation are the most common reasons for renal surgery. In the case of the ureter, which is the connection between the kidneys and the bladder, cancer, kidney stones or constrictions can make surgery necessary. Depending on the specific disease situation, these organs will be partially or completely removed to get rid of any tumours they may contain. The ureter can be replaced with artificial or natural implants. Ureteroscopy or extracorporeal shockwave therapy (ESWT) is used to remove kidney stones.

What preparations are carried out before the procedure?

Urine analysis, ultrasound, contrast agent imaging of the kidneys, CT and MRI are the most common examinations in the case of diseases of the kidney or the ureter. Sometimes, a cystoscopy or a ureteroscopy are also carried out.

All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. The renal or ureter surgery is usually carried out under general anaesthetic. Patients must have an empty stomach for the procedure.

How is the operation performed?

Kidney removal, nephrectomy

Partial or complete kidney removal can be carried out in an open operation or with the minimally invasive laparoscopic method. Nowadays, the gentle minimally invasive procedure is being increasingly used. An open operation is undertaken if the renal cancer has grown into the surrounding tissue or if the lymph nodes have been affected.

The laparoscopic method involves inserting a video camera and surgical instruments into the body via small incisions in the skin. In certain centres, a surgical robot (Da Vinci surgical system) is used to support the surgery. It allows the procedure in question to be carried out even more precisely. 

Whenever possible, the surgeon will try to retain part of the kidneys when conducting the surgery. Complete removal of the kidneys can often be avoided. Firstly, the blood vessels of the kidneys are tied off to restrict the blood supply. If the blood supply is interrupted for a lengthy period, the kidneys are cooled. In this way, damage to the oxygen supply can be prevented. Then the part of the kidneys affected by the disease is isolated and removed. In cases where the entire kidney has to be removed, the ureter is also taken out. 

Ureter surgery

If a patient is suffering from cancer of the ureter, or stenosis of the ureter, the ureter is partially or completely removed. In such cases, it can be replaced with an artificial or a natural implant if the situation allows it. Ureter stents made of plastic-coated metal mesh are used as artificial replacements. They must be changed regularly. In the past, monthly ureteroscopies had to be carried out to do this. Now, there are ureter stents which only required changing once a year.

If the ureter is reconstructed naturally, a part of the small intestine or colon is removed and used as a replacement.

Sometimes the ureter cannot be reconstructed; in this case, the surgeon has to attach a urostomy bag.

Kidney stone removal

Kidney stones do not usually cause any symptoms as long as they are in the kidneys. If they come loose and find their way into the ureter, they cause typical renal colic. Kidney stones can be removed from the renal pelvis or the ureter with a ureteroscopy or with extracorporeal shockwave therapy. During a ureteroscopy, the endoscope is fed through the urethra and the bladder into the ureter or the renal pelvis. This allows smaller stones to be collected using the camera as a guide, and removed with grasping forceps. Larger stones are reduced in size with a laser integrated into the endoscope before they are removed.

Extracorporeal shockwave therapy is a non-invasive procedure used to break up kidney stones. It involves focusing high-energy shockwaves on the kidney stones from the outside of the body. These shockwaves reduce the stones in size so that they can be excreted naturally. Sometimes this therapy is accompanied by a feeling of mild renal colic. Several treatment sessions are required until the kidney stones are all broken up. 

What is the success rate of this procedure?

The disease is usually remedied after the kidney stones have been removed. The prognosis after removal of the kidneys or the ureter due to cancer depends on the stage of the cancer in question. If localised tumours with no metastases are removed, the prospects of recovery after the surgery are high.

What are the possible complications and risks of this procedure?

Kidney surgery and ureter surgery are low-risk routine procedures.  As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections.

What happens after the operation?

The urine catheter which is nearly always inserted after renal or ureter surgery can be removed in several days. Patients who undergo this operation must usually stay in hospital for three to five days.

They should avoid major physical exertion in the first four to six weeks after the operation. After a partial kidney removal, full kidney function can be expected. Please ensure that you drink enough fluid. If one entire kidney is removed, the other kidney is generally sufficient to maintain the kidney function. It is possible to lead a normal life; however, the kidney function should be regularly checked.

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