Nephrectomy: removing a kidneyNephrectomy: gurda nikalna

Yeh kya hai aur kyun kiya jata hai

Hum do gurdon ke saath paida hote hain, lekin aik sehatmand gurda do ka kaam kar sakta hai. Gurda in wajuhaat se nikala ja sakta hai:

• Gurde ka cancer (dekhein gurde ke cancer ki guide). Yeh sab se aam wajah hai. Poora gurda, us ke ird gird ki charbi aur kabhi adrenal gland aur qareebi lymph nodes ke saath nikala jata hai. Isay radical nephrectomy kehte hain.
• Kharab, kaam na karne wala gurda jo dard, infection, khoon ya high blood pressure ka sabab ho, jaise lambi pathri ya rukawat ke baad (dekhein gurde ki pathri ki guide). Yeh simple nephrectomy hai.
• Gurde ke jama karne wale hissay ya ureter ka cancer, jis mein gurda aur ureter aik saath nikale jate hain (nephroureterectomy).

Kuch chhote gurde ki giltiyon mein sirf gilti nikal kar baaqi gurda rakhna mumkin hota hai. Yeh partial nephrectomy hai aur aap ka surgeon batayega ke yeh munasib hai ya nahi. Yeh guide poora gurda nikalne par hai.

Yeh operation open surgery (pehloo ya pait mein bara cut) ya keyhole surgery (laparoscopic, ya robot ki madad se) se ho sakta hai, jis mein kayi chhote cut aur gurda nikalne ke liye aik zara bara cut hota hai. Keyhole se aam tor par dard kam aur recovery jaldi hoti hai, lekin har gurde ke liye munasib nahi.

Operation se pehle

• Scan aur tests: CT ya MRI scan gurda, doosra gurda aur kisi bhi phailao ko dikhate hain. Khoon ke tests dekhte hain ke doosra gurda kitna theek kaam kar raha hai (dekhein CT scan ki guide, gurde ke function tests ki guide aur gurde ke scan ki guide).
• Fitness ka muaina (pre-assessment) aap ke dil, phephron aur aam sehat ko dekhta hai. Sigarette chhodna aur jitna ho sake active rehna recovery mein madad deta hai.
• Khoon patla karne wali dawaon, diabetes, blood pressure ki goliyon aur allergies ke baare mein team ko batayein. Apne taur par koi dawa band na karein.
• Bay-hoshi: operation poori bay-hoshi mein hota hai. Team dard ke ilaaj ke baare mein batayegi jis mein kamar ka injection ya nerve block shamil ho sakta hai.
• Aap se razamandi (consent) maangi jayegi. Poochhein ke kaunsa operation tay hai, kya doosra gurda sehatmand hai, aur pathology ke nateeje ka kya matlab hoga.
• Khoon ka intezam kiya ja sakta hai taake zaroorat par lagaya ja sake. Koi fikar ho to poochhein.
• Qeemat, kitne din hospital mein rehna hoga aur ghar par kya madad chahiye hogi, yeh bhi poochh lein.

Operation ke dauran

Poori bay-hoshi mein surgeon pehloo ya pait ke cut (open) se, ya kayi chhote cut (keyhole) se gurde tak pohanchta hai. Gurde ki khoon ki nalion ko baandh kar ya seal kar ke kaata jata hai, aur ureter ko bhi kaata jata hai. Gurda, ird gird ki charbi aur kabhi adrenal gland ke saath, cut se nikala jata hai, jo keyhole mein zara bara hota hai.

Zakhm ke qareeb nikaasi ki nali (drain) aur bladder mein catheter rakhi ja sakti hai. Operation mein aam tor par do se chaar ghante lagte hain. Gurda laboratory bheja jata hai taake us ka muaina ho.

Operation ke baad aur recovery

Hospital mein

• Aap drip ke saath, aksar catheter aur kabhi drain ke saath hosh mein aate hain. Dard ka ilaaj baqaida hota hai, is liye dard ho to nurses ko batayein.
• Agle din aap ko uthne aur chalne mein madad di jati hai. Saans ki kasrat aur jaldi chalna phephron ki madad karte hain aur khoon ke lothray ka khatra kam karte hain. Aap support stockings pehen sakte hain aur khoon patla karne ke injection lag sakte hain.
• Khana peena jald shuru ho jata hai jab aant kaam karne lagti hain.
• Aam qayam keyhole ke baad chand din, aur open operation ke baad zara zyada hota hai.

Ghar par

• Thakan kuch haftay aam hai. Zaroorat par aaram karein aur chalna aahista aahista barhayein.
• Zakhm ki dekh bhaal: jaisa mashwara ho zakhm saaf aur khushk rakhein. Taanke ghul sakte hain ya nikale ja sakte hain.
• Keyhole ke baad taqreeban chaar se chhe haftay, aur open ke baad zyada, bhaari wazan uthane aur zor wali kasrat se parhez karein, jaisa mashwara ho. Is se hernia ka khatra kam hota hai.
• Dard ka ilaaj: jo dard ki dawayein di gayi hon woh lein. Poochhein ke aap aur aap ke baaqi gurde ke liye kaun si dard ki dawayein mehfooz hain.
• Kaafi paani peeyein siwaye is ke ke aap se kam karne ko kaha gaya ho. Qabz se bachein.
• Gaari aur kaam: team se poochhein. Daftar ka kaam karne wale bohat se log kuch haftay baad wapas aate hain, bhaari kaam mein zyada waqt lagta hai.

Mumkina khatrat aur aik gurde ke saath zindagi

• Aam: dard, thakan, neel, saans ki nali se galay mein dard, aur kuch haftay zakhmon par takleef.
• Kam aam: zakhm ya seene ka infection, peshab ka infection, aur baad mein zakhm par ubhaar ya gaanth (hernia).
• Ghair aam: khoon jis ke liye khoon lagwana ya doosra operation pare, taang ya phephre mein khoon ka lothra, aur keyhole operation ka open surgery mein badalna.
• Bohat kam: qareebi aza jaise aant, tilli, jigar, pancreas ya phephre ke ghilaf ko chot, paani ka reesna, ya anaesthetic ke khatrat.
• Gurda nikalne ke baad: gurde ki kaam karne ki salahiyat kam hoti hai, lekin baaqi gurda barh kar zyada kaam karne lagta hai. Agar doosra gurda sehatmand na ho to gurde ki salahiyat ko zyada khatra hota hai. Lambay arsay mein high blood pressure ya gurde ki bimari ka imkaan thora barh jata hai, is liye baqaida jaanch ahem hai.
• Agar operation cancer ke liye tha to cancer ke wapas aane ka imkaan hota hai, isi liye follow-up ahem hai.

Aik gurde ke saath zindagi

• Zyadatar log aam mehsoos karte hain, aam khana khate hain aur kisi khaas parhez ki zaroorat nahi hoti.
• Kaafi paani peeyein, blood pressure qaboo mein rakhein aur sigarette se bachein.
• Soojan kam karne wali dard ki dawayein (anti-inflammatory painkillers) lene se pehle apne doctor se poochhein kyunke woh gurde ko nuqsan pohancha sakti hain. Nayi dawayein khareedne se pehle pharmacist se poochh lein.
• Takrane wale khel baaqi gurde ke liye khatra hain. Apne doctor se poochhein aur khelte hue us ko bachayein.
• Jo bhi doctor ya nurse aap ka ilaaj kare use batayein ke aap ke paas aik gurda hai.

Nateeje aur follow-up

• Pathology ka nateeja aam tor par aik do haftay mein aata hai. Is se pata chalta hai ke asal mein kya nikla, cancer ho to us ki qisam aur stage, aur kya mazeed ilaaj chahiye. Poochh lein ke nateeja kab aur kaise bataya jayega, aur yaqeeni banayein ke aap ko mile.
• Cancer ka follow-up: kuch saal baqaida check-up, scan aur khoon ke tests hote hain taake dobara aane ka pata chale (dekhein gurde ke cancer ki guide).
• Gurde ki kaam karne ki salahiyat aur blood pressure zindagi bhar baqaida dekhe jate hain, aap ki hospital team ya family doctor ke zariye (dekhein gurde ke function tests ki guide).
• Agar peshab mein khoon, naya dard ya gaanth nazar aaye to jaldi apne doctor ko batayein (dekhein peshab mein khoon ki guide).

Aam sawalaat

What it is and why it is done

We are born with two kidneys, but one healthy kidney can do the work of two. A kidney may be removed because of:

• A kidney cancer (see the kidney cancer guide). This is the commonest reason. The whole kidney, together with the fat around it and sometimes the adrenal gland and nearby lymph nodes, is removed. This is called a radical nephrectomy.
• A damaged, non-working kidney that is causing pain, infection, bleeding or high blood pressure, for example after long-standing stones or blockage (see the kidney stones guide). This is a simple nephrectomy.
• A renal pelvis or ureter cancer, where the kidney and ureter are removed together (a nephroureterectomy).

In some small kidney tumours it is possible to remove only the tumour and keep the rest of the kidney. This is a partial nephrectomy and your surgeon will say if it is suitable. This guide focuses on removing the whole kidney.

The operation can be done by open surgery (a larger cut in the side or abdomen) or by keyhole surgery (laparoscopic, or robotic-assisted), through several small cuts, with one slightly larger cut to take the kidney out. Keyhole surgery usually means less pain and a quicker recovery, but not every kidney is suitable.

Before the operation

• Scans and tests: CT or MRI scans show the kidney, the other kidney and any spread. Blood tests check how well the other kidney is working (see the CT scan guide, the kidney function tests guide and the kidney scan guide).
• A fitness check (pre-assessment) looks at your heart, lungs and general health. Stopping smoking and being as active as you can help recovery.
• Tell the team about blood thinners, diabetes, blood pressure tablets, and allergies. Please do not stop any medicine on your own.
• Anaesthetic: the operation is under a general anaesthetic. The team will explain pain relief, which may include a back injection or nerve block.
• You will be asked for consent. Please ask which type of operation is planned, whether the other kidney is healthy, and what the pathology result will mean.
• Blood may be arranged in case you need a transfusion. Ask if you have any concerns.
• Ask about the cost, how many days you will stay and the support you will need at home.

During the operation

Under general anaesthetic, the surgeon reaches the kidney through a cut in the side or abdomen (open), or through several small cuts (keyhole). The blood vessels to the kidney are tied or sealed and divided, and the ureter is divided. The kidney, with the surrounding fat and sometimes the adrenal gland, is taken out through a cut, which in keyhole surgery is slightly larger.

A drain (a thin tube) may be left near the wound, and a catheter in the bladder. The operation usually takes two to four hours. The kidney is sent to the laboratory to be examined.

After the operation and recovery

In hospital

• You wake up with a drip, often a catheter, and sometimes a drain. Pain relief is given regularly, so please tell the nurses if you are in pain.
• You are helped to get up and walk the next day. Breathing exercises and early walking help your lungs and lower the risk of blood clots. You may wear support stockings and have injections to thin the blood.
• Eating and drinking restart quickly, once the bowel works.
• Typical stay is a few days after keyhole surgery, and a bit longer after open surgery.

At home

• Tiredness is common for some weeks. Rest when you need to, and build up your walking.
• Wound care: keep the wounds clean and dry as advised. Stitches may dissolve, or be removed.
• Avoid heavy lifting and strenuous exercise for about four to six weeks after keyhole surgery, and longer after open surgery, as advised. This helps prevent a hernia.
• Pain relief: use the pain relief you were given. Please ask which painkillers are safe for you and your remaining kidney.
• Drink enough fluid unless told otherwise. Avoid constipation.
• Driving and work: ask the team. Many people with desk work return after several weeks, but heavy work takes longer.

Possible risks and living with one kidney

• Common: pain, tiredness, bruising, a sore throat from the breathing tube, and discomfort at the wounds for some weeks.
• Less common: a wound or chest infection, a urine infection, and a lump or bulge at the wound later (a hernia).
• Uncommon: bleeding that needs a transfusion or another operation, a blood clot in the leg or lung, and a keyhole operation needing to be changed to open surgery.
• Rare: injury to nearby organs such as the bowel, spleen, liver, pancreas or the lung covering, a leak of fluid, or the risks of the anaesthetic.
• After removal: kidney function falls, but the remaining kidney grows to do more of the work. If the other kidney is not healthy, the risk to kidney function is greater. There is also a small long-term rise in the chance of high blood pressure or kidney disease, so regular checks matter.
• If the operation was for cancer, there is a chance the cancer can come back, which is why follow-up is important.

Living with one kidney

• Most people feel normal, eat as usual and need no special diet.
• Drink enough fluid, keep your blood pressure in check, and avoid smoking.
• Ask your doctor before taking anti-inflammatory painkillers, as they can harm kidney function. Check with a pharmacist before buying new medicines.
• Contact sports carry a risk to the remaining kidney. Ask your doctor, and protect it if you play.
• Tell any doctor or nurse who treats you that you have one kidney.

Results and follow-up

• The pathology result usually takes one to two weeks. It tells you exactly what was found, the type and stage of any cancer, and whether more treatment is needed. Ask how and when you will be told, and make sure you receive the result.
• Follow-up for cancer: you will have regular check-ups with scans and blood tests for some years, to look for any return (see the kidney cancer guide).
• Kidney function and blood pressure are checked regularly for life, by your hospital team or your family doctor (see the kidney function tests guide).
• If you notice blood in the urine, new pain, or a lump, tell your doctor promptly (see the blood in urine guide).

Common questions