Open Nephrectomy

  • Reference Number: HEY-462/2018
  • Departments: Urology

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is an open nephrectomy?

Following the results of investigations and discussion with your doctor it has been decided that you should have a nephrectomy. This involves removing your kidney (and sometimes the ureter too) through an incision in the side of your abdomen.  This cut is usually 15 – 20 cms long. This operation is performed under a general anaesthetic and usually takes around 1 – 2 hours.

Why do I need a nephrectomy?

 Your doctor will have discussed the reasons with you why it is necessary to remove your kidney. It may be that your kidney is diseased in some way, or that it is not functioning properly.  Your body can function normally with just one kidney.

Can there be any complications or risks?

All operations requiring an anaesthetic carry with them a small chance of complications. Every care is taken to keep the risks as low as possible.

The potential complications include:

Occasional (between 1 in 10 people and 1 in 50 people may experience)

  • Bleeding requiring further surgery or a blood transfusion
  • Puncture of the lung cavity requiring insertion of a temporary drainage tube
  • Need for additional treatment after surgery
  • Chest infection, urine infection or wound infection  

Rare (less than 1 in 50 people may experience)

  • Anaesthetic or cardiovascular problems possibly requiring admission to intensive care. These reasons may include chest infection, blood clots in the lung or calf, stroke or heart attack.
  • Involvement or injury to organs in your body near to your kidney requiring more extensive surgery

How do I prepare for my operation?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.  Leaflets are available to relatives and visitors containing useful information on the ward.

Smoking

If you are a smoker, it would benefit you greatly to stop smoking or cut down before you have your operation. If you need further information about stopping smoking please contact:

  • Your GP
  • Hull and East Riding Stop Smoking service. Free phone 0800 915 5959
  • North East Lincolnshire and North Lincolnshire NHS Stop smoking services 0845 6032166 (local rate)
  • Smokefree 0800 022 4 332       http://smokefree.nhs.uk/

Pre-Assessment

You will attend a pre-assessment appointment 1 – 3 weeks before your surgery which will give you an opportunity to discuss your surgery with a nurse and ask any questions you may have. The nurse will also take some general information from you and perform some routine checks such as blood pressure and pulse rate, some blood tests and swabs.  You may also undergo some other routine tests such as a heart tracing and chest X-ray.  This is to ensure that you are well enough to have your surgery.  The nurse will also inform you if you need to stop taking any medications in the days prior to your surgery such as clopidodrel or warfarin and also which medications you should continue to take before your surgery.  When you are admitted to hospital you will need to bring your nightwear, dressing gown, slippers and toiletries with you.

Preparing for your discharge home

The anticipated length of stay in hospital for your operation is 3 – 5 days. This is not to say that you will be in hospital for this amount of time, it may mean that you need to stay longer than this, or, you may recover more quickly than this and require less time in hospital. When you are admitted to the ward the nurse will give you an expected date of discharge. You will be seen by the surgical team on a daily basis who will decide when you are well enough to go home. When a discharge date is agreed you can expect in most cases to be discharged home from hospital by late morning, however sometimes if we are still waiting for some medication for you to be supplied you may be asked to wait for this in the dayroom or discharge lounge.  It is a good idea to stock your freezer with easy to prepare meals for when you get home. Try and arrange for friends and family to do your shopping and any heavy work for you, especially for the first two weeks following discharge. Please let your doctor or nurse know if you have any concerns or feel you may have difficulties looking after yourself when you get home.

Medication  

You will need to bring with you all the medication that you are currently taking. You will also need to arrange a 28 day supply of your usual medication ready for when you get home. The nurse will also check you have the right medication to go home with and give you information about your medicines. You may have been given some pain relief medication to take home (if not, take mild pain relief medication such as you might take for a headache).

What happens before the operation?

  • You may be admitted directly to the ward the evening before your surgery. You may be admitted to the Surgical Admissions Lounge where you will be prepared for your surgery and transferred to the ward following your operation or you may be admitted directly to the ward. You will receive written information about this and any pre-operative instructions that you need to follow. You will need to bring nightwear and slippers with you.
  • The nurse will show you to your bed and also show you around the ward.
  • Please read the patient information file available for you at your bedside which contains useful information about your hospital stay.
  • You are at increased risk of developing a blood clot due to reduced activity during your hospital stay and so, to help prevent this we will give you a small injection (which you will receive each day) and also ask you to wear some fitted support stockings to help reduce the risk of blood clots.
  • You will also receive instructions asking you not to eat or drink anything before your operation. What happens on the day of the operation?

What happens on the day of the operation?

  • You will be asked to have a bath or shower and change into a hospital gown.
  • You will meet the doctors and nurses involved in your care.
  • The anaesthetist will visit you to discuss your anaesthetic. You will also have the opportunity to discuss the types of pain relief available to you. The types of pain relief you may be offered are usually ones that you can administer yourself when you need them. This is usually delivered through a cannula in your hand or arm and into your bloodstream, or into your back known as an epidural. You will receive more information on this at your pre-assessment appointment.

After your operation

  • You will wake up in the recovery area before returning to the ward. You will be then transferred into the High Observation Bay on the ward. This is purely routine and the higher ratio of nurses to patients means that they can monitor you more closely.
  • You may be very sleepy and be given oxygen through a clear face mask to help you breathe comfortably after your operation.
  • The surgeon will have placed a catheter in your bladder to drain your urine. If you have had the tube from your kidney to your bladder removed you will keep this catheter for a few days. Otherwise it will be removed as soon as you are up and about and the doctors are happy with your recovery.
  • You may have a narrow plastic tube (drain) inserted during the operation that will be placed near your wound. This is so that any blood or fluid that collects in the area can drain away safely. This is usually removed after
    1 -2 days.
  • You may be attached to an intravenous infusion also know as a ‘drip’ to prevent dehydration. You will be able to eat and drink as soon as you feel able.
  • You will already have a plan of care in place to ensure that your pain is controlled to an acceptable level. Please make sure that you have read the patient information leaflet that you have been given about this. If you feel that your pain is not sufficiently controlled please inform your nurse straightaway.
  • You will be able to get out of bed the day after your surgery. You are encouraged to mobilise as soon as it is safe to do so because it reduces your risk of developing a chest infection or blood clot (thrombosis). Until you are independently mobile you will wear some support stockings around your lower legs. This is to keep the blood flowing in your veins and will reduce any risk of developing a blood clot (deep vein thrombosis).
  • Your blood pressure, pulse, oxygen levels and temperature will be checked frequently. The nurses will also check your skin regularly and encourage regular positional changes to prevent any tissue damage (pressure sores).
  • The surgeon who performed your surgery will visit you afterwards on the ward. Each day that you are in hospital a consultant and team of doctors will review your care.

Recovering at home – when can you get back to normal?

  • Your recovery period will take anything up to three months. It is very normal to feel very tired for a couple of weeks.
  • Strenuous exercise (such as cutting the grass) or heavy lifting should be avoided for six weeks following surgery. You should gradually build up the amount of exercise you do over this time.
  • Most wounds have dissolvable stitches which do not need removing. However if you have another type of stitch or if you have skin clips in these will need removing by the district nurse around 8 – 10 days after your surgery. The nurse will arrange this for you. You will receive written advice on the best way to care for your scar and how you can help your scar to heal.
  • You should not require a dressing on your wound when you get home. You may bathe and shower as normal.
  • You are at increased risk of developing blood clots (venous thromboembolisms) in the weeks following your hospital admission and will have been given support stockings to wear for six weeks. It will help reduce the risk if you keep active. If your calf becomes swollen, red and painful, or if you should experience chest pains or difficulty in breathing you must seek immediate medical advice either by telephoning the ward on which you were a patient, call the NHS 111 service, or contact your GP. Alternatively you can attend the hospital Emergency Department.

Please make sure that you read the leaflet given to you ‘Venous Thromboembolism (VTE) – Reducing the risk’ carefully in the patient information pack at the side of your hospital bed.

Contact your doctor if:

  • You experience flu like symptoms a few days after discharge home
  • Your wound does not appear to be healing, or is leaking or becoming red and swollen

Driving after surgery

  • It is your responsibility to ensure that you are fit to drive following your surgery. However you should refrain from driving for at least six weeks following this surgery. Your doctor will be happy to provide you with advice on request.  If you are unsure, please contact the DVLA.
  • The nurse discharging you from hospital will check that you understand the advice given to you in this leaflet. You will also be given an Immediate Discharge Letter which is a summary of your hospital visit.  This will include details about further appointments that have been made following your surgery.
  • You may wish to ask advice about when it will be safe for you to return to work.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Urology Department on telephone number (01482) 623015

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.