Heminephrectomy

What is heminephrectomy?

Heminephrectomy is a surgery in which part of the kidney is removed.

Who needs to have a heminephrectomy?

This procedure is done when part of a kidney (or both kidneys, in rare cases) is not working correctly. Removing the unhealthy part allows the rest of the kidney to work better This problem with the kidney can be something that a person has had since birth or it may have developed as the result of an infection, disease, or accident.

People who need a heminephrectomy often have a problem known as a duplex kidney. This is a condition in which one or both kidneys have two ureters. Ureters are the tubes through which urine leaves the kidney and goes to the bladder. A typical kidney only has one ureter. With a duplex kidney, each of the two ureters can go to the bladder on its own, or they may meet up at some point and enter the bladder together.

Having a duplex kidney is not always bad. In fact, some people never know they have it. However, it can cause problems. One example is a condition known as vesicoureteral reflux, in which urine in the bladder flows back into the ureter and can reach the kidneys. This can damage the kidneys over time. If a person develops a urinary tract infection, scarring can develop in the kidney. Another problem that can occur with duplex kidneys is if one of the ureters does not drain into the bladder but instead drains into nearby organs, which can damage them. Also, sometimes the ureter forms a balloon as it enters the bladder. This is known as an ureterocele.

How do I know if I have a duplex kidney, or another problem with a kidney?

Some people with duplex kidneys get bladder or urinary tract infections often. These can cause pain upon urinating or a feeling of needing to go to the bathroom even though the bladder is not full. Although many people get a urinary tract infection from time to time, people who get them a lot should talk to a doctor about the chance they have a more serious problem.

Other signs that you might have something wrong with one or both of your kidneys include seeing blood in your urine, having pain in your lower back, having little appetite, or feeling a lump near your stomach.

If your doctor thinks you might have a problem with one or both of your kidneys, he or she can order tests. Sometimes dye is injected into the bladder to see if it travels back up the ureters toward the kidney. Other tests may include:

• Blood tests
• Ultrasound
• CT scan
• MRI

How is a duplex kidney treated?

A heminephrectomy is one treatment option for these problems. There are other options as well, including using antibiotics to prevent infections and surgery to repair the ureter that is causing the problem. The right choice will depend on many factors, including how well the kidney is functioning and what kind of problems you are having.

What other times might a heminephrectomy be used?

Heminephrectomies also may be needed in patients with a kidney that has been severely injured, such as in a car accident. People with diseases such as cancer that is affecting part of the kidney also may have the procedure. For many people, the removal of the damaged area can allow the rest of the kidney to keep working well.

What does a heminephrectomy involve?

Surgeons can often remove the bad part of the kidney in a minimally invasive way, such as with laparoscopic surgery. This type of surgery involves a small incision and a fairly quick recovery time. Most patients are given drugs to put them to sleep for the procedure. The doctor will place a catheter (thin, flexible tube) in the bladder to help with urination for the first few days.

Most people are able to go home from the hospital after the catheter is removed. Your doctor may ask you to follow a special diet for a while and to avoid heavy activities while you heal.

Complications are rare. As with any surgery, however, complications can include bleeding, infection, or damage to nearby organs such as the bowels, liver, or spleen.

What happens after a heminephrectomy?

You can live a healthy life with only one kidney. People who have had part of one kidney removed also are able to be healthy because the partial kidney is still able to do at least part of its job. However, people who do not have two complete kidneys may be at risk for high blood pressure. You will probably also need to have urine or blood tests done from time to time to make sure the kidneys are doing a good job of removing toxins from the blood.