Urology Casablanca

This procedure is intended to remove a kidney affected by a tumour. Anatomical reminder The kidney is an organ that plays the role of a filter that participates in the purification of the blood and the elimination of waste from the body. The kidneys are usually two in number. They are located in the abdomen under the chest, on either side of the spine. The urine produced by the kidneys is drained by the ureters towards the bladder where it is stored between two urinations. A single kidney may be sufficient to carry out this purification function. Legend: R: kidney; S: adrenal gland; U: ureter; AR: renal artery; RV: renal vein; AO: aorta; VCI: inferior vena cava

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Why this action? The examinations carried out by your doctor revealed a tumor in the kidney. The size of the tumor and its location make it possible to consider keeping part of the kidney; thus, the surgical treatment which is proposed to you consists in removing the part of the kidney which is the seat of the tumour. Nevertheless, the final decision can only be taken at the time of the operation, depending on the per-operative anatomical findings. The benign or malignant nature of this tumor will only be known definitively after analysis of the tissues under a microscope. This operation is necessary because, in the absence of treatment, this tumor exposes you to the risk of clinical disorders (pain, bleeding, fever, etc.). If this tumor is cancerous, only surgical treatment can prevent the progression of the disease. Are there other possibilities? The complete removal of your kidney carrying a tumor would also make it possible to obtain both a definitive diagnosis of this lesion and to treat you. Your urologist has explained to you why he is suggesting partial kidney surgery.

Preparation for the intervention As with any surgery, a pre-operative anesthesia consultation is required a few days before the operation. The operation takes place under general anesthesia. Surgical technique Several approaches allow access to the kidney. The choice will be made according to the location of the tumour, your morphology and the habits of your surgeon. Depending on the size and location of the tumor, it is possible that a probe will be placed in the ureter at the start of the operation. In case of opening of the urinary cavities of the kidney, this probe will facilitate suturing. The surgical gesture consists in removing the tumor with a margin of safety with the normal kidney. At the end of the operation, one or more drains or blades can be put in place. They make it possible to monitor the flow through the surgical site. Usual suites The stomach is usually put to rest by a small tube coming out through a nostril, in order to avoid vomiting, a source of pain at the level of the scar. To monitor the proper functioning of the kidneys and prevent you from having urinary difficulties when you wake up, a urinary catheter is placed during anesthesia. This probe can be, rarely, responsible for discomfort. The pain associated with the intervention is due to painkillers which will be administered to you regularly. You are usually allowed to get up the day after the operation and to eat again as soon as intestinal transit resumes. The time of removal of the drain(s) and the urinary catheter is variable and will be defined by the surgeon. Hospitalization lasts about a week and a convalescence of a few weeks is necessary. You will discuss with your surgeon the date of return to work if necessary and the follow-up after the operation. The follow-up that you will undergo after the intervention meets two objectives: - check the absence of recurrence in the event of a cancerous tumour. - monitor the functioning of the kidneys.

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In the immediate postoperative suites - bleeding which may require a new operation. - risk of phlebitis and pulmonary embolism. - risk of infection, in particular of the wall (that is to say of the skin and muscles which cover the operated area) and of the adjacent lung. - digestive complications: delay in the resumption of intestinal transit or true occlusion which can sometimes justify a reoperation; stomach ulcer. - rarely obliteration of the renal artery responsible for the permanent loss of the kidney. - urinary fistula due to poor healing of the excretory pathway, causing urine to leak through the wall drainage or through the scar. Most often, your surgeon will suggest that you drain the excretory pathway using an exterior probe or an internal probe to dry out the fistula. Nevertheless, in case of failure, a new operation may be indicated to close the excretory pathway, or even to remove the kidney. - in a patient who has only one kidney: possibility of recourse to the artificial kidney in principle temporarily but exceptionally definitively. Remote Risks As in any abdominal intervention, deformations of the wall of the abdomen, more or less important, and intra-abdominal flanges can occur. Your urologist is at your disposal for any information.

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