DR. VIVEK VENKAT

Cancer is an abnormal growth of cells in the kidney which progress to form a malignant tumor which can spread to other organs and threaten the life of the patient.
Cancer arising in the renal pelvis and ureter is not very common and accounts for 6-8% of kidney cancer.
It is called urothelial carcinoma or transitional cell carcinoma and is similar to cancer from the urinary bladder.

• Radical or total nephro-ureterectomy is a surgery where the entire kidney and ureter with a small cuff of the bladder along with local lymph nodes are removed.
• It is the treatment of choice for most cancers of the ureter and renal pelvis.
• It can be done by an open surgery or via a minimally-invasive robotic approach.
• For patients For patients with reduced kidney function or low-grade tumors it may be possible to remove only the segment of the ureter that has the tumor or to ablate (destroy) it with LASER ureteroscopy. These options may have a higher recurrence rate and need close monitoring.

Robotic surgery provides significant benefits for both patient and surgeon.

• Smaller and less incisions with less pain and scarring.


• Shorter hospital stay and quick return to normal activities.


• Reduced bleeding and blood transfusion rates.


• Lower risk for wound infection.


• Excellent magnified view allowing precise surgery and preservation of other organs.


• Much more ergonomic than laparoscopy.


• Excellent approach for the lower ureter and bladder cuff without the need for additional incisions.

Every surgery carries a risk of complications. General complications may include anesthesia-related problems. infection, blood clots (DVT), pneumonia, cardiac events, etc. In addition, certain specific complications include:

• Bleeding: The kidney receives 20% of the blood pumped out from the heart with each heartbeat and is a very vascular organ. Kidney cancers generally have a very robust blood supply and can even invade adjacent blood vessels. Bleeding is a significant risk in these surgeries and transfusion may be required.
• Injury to adjacent organs: In cases of large tumors, adjacent organs like the spleen, tail of pancreas, intestines, etc. may be stuck to the tumor or affected kidney. Sometimes this cannot be conclusively seen on the CT scan or MRI and the organs may need to be removed during the procedure.
• Delay in the recovery of intestinal function (ileus) – This can happen after more extensive surgeries and may take up to a week to resolve sometimes.
• Urine leak from the bladder cuff is uncommon and usually resolves by itself.

How to prepare for nephro-ureterectomy?

After your imaging and staging tests you will discuss your options with your urologist:
• The need for conservative surgery or radical nephro-ureterectomy?
• Whether you are a candidate for a robotic procedure?
• What further treatments might be needed?

To proceed with surgery the general instructions are:
• Basic blood and urine tests to assess fitness for surgery
• Cardiac evaluation like ECG and 2D-Echo
• To stop blood thinning medication for 5-7 days before the surgery
• Anesthesia check-up and assessment
• Healthy diet and exercise until the surgery
• Admission the day prior or day of surgery

What to expect after surgery?

• Speed of recovery depends on the extent of the surgery.
• After most robotic cases resumption of a liquid diet is within 6-8 hours after surgery and normal food the next day.
• You will also be able to get out of bed and walk a few hours after surgery.
• Pain after robotic surgery is mild and easily controlled with medications. For open surgery and more extensive cases stronger painkillers or epidural analgesia may be needed.
• You will have a urinary catheter to drain the bladder for 4-5 days and an abdominal drain as well.
• Most patients are discharged in 3-5 days. Open cases or more extensive surgeries may need a longer post-operative stay of 3-7 days
• You can resume light work in about 4 weeks after surgery.
• You can walk as much as you like but we recommend avoiding strenuous activity like lifting weights, golfing, going to the gym, etc. for 6 weeks after surgery.

What are the results of nephro-ureterectomy? What monitoring is needed for the single kidney?

• Radical nephro-ureterectomy is the gold standard for ureteral and renal pelvis cancers.
• It has an excellent success rate and the exact prognosis depends on the stage and pathology of the tumor.
• Robotic surgery has much lower complications and quicker recovery than open surgery with no compromise in cancer control.
• Once the biopsy report is available you can discuss the follow-up schedule and tests with your uro-oncologist
• Monitoring your kidney function is important after a nephrectomy especially in patients who have diabetes or hypertension or are obese. Blood pressure levels, sugar monitoring, blood tests like creatinine and urine protein levels are important indicators of kidney function and should be followed regularly.
• Healthy diet with reduced salt, reduced sugar and red meat may be recommended.
• Regular exercise and weight loss in obese patients are important to protect the kidney.
• Avoid dehydration.
• Check with your doctor before taking any medications especially painkillers.