Advice after your nerve block for surgery
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This page aims to explain the procedure you will have whilst in hospital, it serves as a guide. If any questions arise from reading this information, please speak to one of the Kidney Cancer Nurse Specialists (direct line numbers are at the end of this booklet).
The kidneys are a pair of organs located at the back of the abdomen which filter blood to remove waste products producing urine. The urine is carried from each kidney to the bladder via a tube called the ureter. The urinary bladder stores the urine. When the bladder is full the urine passes out of the body through a tube called the urethra. The urethra opens immediately in front of the vagina in women and at the tip of the penis in men.
Urothelial carcinoma (also called transitional cell carcinoma or TCC) is a cancer of the lining of the urinary system. It begins in the urothelial cells which line the urethra, bladder, ureters and renal pelvis.
If you are diagnosed with a TCC, it’s important to know:
- The size of the tumour. Small tumours (<2 cm) might be suitable for endoscopic and laser treatment.
- How far your cancer has grown or spread (stage).
- How aggressive the cancer cells are (grade).
- If you have a normal contralateral kidney.
- Your general health
- Your age and level of fitness
The earlier your cancer is found, the easier it is to control and possibly cure.
The most common treatment for TCC of the kidney is surgery. Surgery for this type of cancer is usually a major operation and you need to be fit enough to make a good recovery. In some cases, endoscopic treatment with laser ablation might be appropriate.
The aim of the surgery is to remove the kidney and the small part of the bladder surrounding the ureter opening (the bladder cuff) which may be affected by the tumour.
At Frimley Renal Cancer Centre, your laparoscopic ‘keyhole’ radical nephroureterectomy may be performed either robotically or laparoscopically using conventional laparoscopic instruments. The wounds from each type of surgery are very similar.
Robotic assisted laparoscopic nephroureterectomy
For this operation you will receive a general anaesthetic and it is a minimally invasive surgery.
During the procedure the surgeon inserts small metallic tubes (called ports) into your abdomen. They inflate your abdominal or retroperitoneal cavity with carbon dioxide gas to create working space. A surgical robot system (da Vinci) is attached to these ports. Miniaturised wristed instruments and a high-definition 3D camera are inserted down the ports. Your surgeon views a magnified, high-resolution 3D image of the inside of your body. The robot then seamlessly translates your surgeon's hand movements into precise micro-movements of the da Vinci instruments. This technique is used frequently due to its high degree of surgical accuracy and fast recovery. Although it is often called a “robot”, the da Vinci System cannot move or operate on its own; your surgeon is 100% in control.
After the affected kidney is identified, the blood supply is disconnected using special clips. The surgeon follows the ureter all the way down towards the bladder. By pulling the ureter the surgeon can identify the bladder cuff and can remove it. The hole in the bladder is then repaired with sutures.
Laparoscopic Radical Nephroureterectomy
For this operation you will receive a general anaesthetic and it is a minimally invasive surgery.
There are 3 parts to this operation:
Initially you will lay on your back and a camera is passed through your water pipe (urethra). The surgeon then detaches the ureter on the affected side from your bladder and a catheter to drain your bladder is inserted.
You are then turned onto your side for removal of your kidney. For laparoscopic procedures, the surgeon inserts small plastic tubes (ports) into your abdomen to allow passage of surgical instruments. The surgeon will identify and free the kidney, then proceed to free the ureter down towards the bladder.
A cut is then made in your lower abdomen which allows the surgeon to free the rest of the ureter and the whole specimen is removed.
Both operations usually take between 3-5 hours, although you will be away from ward for longer due to anaesthetic time and recovery time.
What are the risks of the Radical Nephroureterectomy?
Any operation and anaesthetic carries risks, these are however generally small. Risks of the anaesthetic can be discussed with the anaesthetist who will be looking after you during the procedure and will visit you before the operation.
Possible problems with the procedure can include:
- Shoulder tip pain
- Abdominal bloating
- Wound infection
- Bleeding. In some cases (less than 5%) heavy bleeding may require a blood transfusion
- The need to convert to an open procedure, (less than 1%) requiring a bigger cut
- Adrenal gland removal
- Injury to bowels / liver / spleen / blood vessels
- Kidney function impairment
- Urine leak
- Drain
- Pelvic collection
- Tumour rupture
- Risks associated with anaesthetics such as DVT / PE / chest infection / heart attack
What happens before the operation?
You will be invited to the Pre-Operative Department (POD) before your operation to assess your general fitness, screen for MRSA and for some baseline bloods, urine tests and ECG of your heart.
It would be useful if you could bring in a list of any medications that you normally take at home and let us know of any drug allergies you may have.
IT IS IMPORTANT TO LET THE HOSPITAL KNOW IF YOU ARE ON ANY DRUGS THAT THIN THE BLOOD, e.g., Aspirin, Warfarin, Clopidogrel, Dipyridamole, Edoxaban, Apixaban, etc.
Day of your admission to hospital
- You may eat and drink up to 6 hours before your operation.
- You will be admitted to a ward on the day of your operation. You will go to theatre from here and then return to your allocated ward.
- It would be helpful if you could bring a supply of your usual medications to take whilst in hospital.
- Any tests not carried out before admission will be performed before your operation.
- Depending on what medication you take you may be asked to have your normal medications, or some may be withheld and given to you after the operation.
- You will be asked to bathe before the operation at home. On the ward you will put on a theatre gown and to wear some special stockings during and after the operation. These stockings aim to reduce the risk of developing blood clots (DVT) in your lower legs.
- A surgeon and a Kidney Cancer Nurse Specialist will come and see you on the day of your procedure and go through the consent form with you.
- The anaesthetist will come and see you and discuss your medical history, the anaesthetic and pain relief that will be used.
After your operation
After your operation, you will normally wake up in the recovery department, where you will stay until you are fully awake, comfortable, and ready to be transferred to the ward. You will have a ‘drip’ to keep you hydrated and this can be used to give you medications. You will also have your blood pressure, pulse, oxygen levels and temperature checked regularly.
Once you are back on the ward, we will get you sitting up and out in the chair as soon as possible. The nurses will offer you water to drink, progressing to tea and coffee and a light diet when you are ready. You will have a catheter draining urine from your bladder. You may also have a drain from the operation site to stop any excess fluid collecting, although this is rare.
You should expect some discomfort, but this should be controlled using the painkillers you will be prescribed. If you still have pain, it is important you let the ward staff know as soon as possible so additional pain relief can be given.
The renal cancer team will review you, discuss your operation, your recovery plan and the follow up plan. You will be encouraged to start moving about as much as possible, walking around the ward, eating, and drinking normally and getting ready to go home. You will be encouraged to do some exercises, including regular leg movements and deep breathing exercises.
Post operative intravesical chemotherapy
After your surgery, the consultant may offer you a single dose of chemotherapy into your bladder depending on the size of the tumour and other factors. This helps to lower the risk of bladder cancer in the future.
This drug is called Mitomycin C and is a bladder wash which can destroy any microscopic cancer cells. If this treatment is recommended, the CNS will discuss this with you further after your surgery and then if you agree, will give you the drug through the catheter already in place.
A valve will be inserted so that the drug stays in your bladder. After one hour, the valve will be opened, and the drug will be drained. The catheter will remain in place for a further 5 hours before being removed.
The surgeon may recommend your bladder is given a couple of weeks to heal before receiving this treatment or removing the catheter. In such cases, we may perform a cystogram (a special x-ray to ensure the hole in the bladder has healed) before administering this treatment and / or removing the catheter. If this is the case, the CNS will arrange this for you before you are discharged.
You will be taught how to look after the catheter and be given all the necessary supplies before being discharged.
The tumour will be sent off to be looked at using a microscope, the results (histology) will confirm the type of tumour and the follow-up arrangement that will be necessary.
Going Home
Most patients leave hospital the day after the operation. A small number of patients might need to stay for an extra night. On discharge, you will be comfortable and will be given painkillers and laxatives to take home with you.
Please make arrangements for someone to collect you, as you will not be fit to drive home following an anaesthetic.
Be sensible when you get home – you have had major surgery so you should not undertake strenuous physical exercise, even if you feel able, for approximately 4-6 weeks.
Before driving, you need to be confident that you can perform an emergency stop and therefore we advise you wait 4 weeks before attempting to drive.
If you develop any of the following:
• Smelly cloudy urine
• Blood in the urine
• Fever
• Pain
• Shivering
• Frequency of passing urine
• Burning sensation when passing urine
• Feeling unwell
• Red, inflamed, or oozing wound
Please seek advice from the Kidney Cancer Nurse Specialist in normal office hours.
If out of hours / weekends, please call the Surgical Assessment Unit (SAU) helpline on 0799 052 8061
In an emergency dial 111 or attend your local A&E department.
Follow-up
When you leave hospital, you should be aware of when you are coming back for results or further tests.
If you do not hear from us, please get in touch so we can ensure appointments have been made for you.
After surgery you will receive a face to face appointment with a member of the Renal Cancer Team. During this appointment the results of the surgery will be discussed with you and if follow-up is recommended you will be informed.
Useful Telephone Numbers/contacts
Sister Jo Oakley Kidney Cancer CNS 0300 613 2426
Sister Kate Brown Kidney Cancer CNS 0300 613 5804
FRCC Senior Clinical Admin Officer 0300 613 4450
Appointments 0300 613 4201
Radiology Department 0300 613 4140
Pre-Operative Department 0300 613 2157
Contact us
If you have any queries relating to this information, please contact the Urology service.
About this information
Service:
Urology
Reference:
Z/047
Approval date:
19 July 2024
Review date:
1 June 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.