Heminephrectomy

What is a heminephrectomy?

A heminephrectomy (hem-ee-nuh-FREK-tuh-mee) is a type of surgery that removes part of your kidney.

It’s normal to feel worried, anxious or even afraid about any type of surgery, especially one that affects an important organ. Healthcare providers understand your feelings. They’ll thoroughly explain the procedure to you, including the expected outcome and the recovery process, and answer any questions you have.

What does a heminephrectomy treat?

People who need a heminephrectomy often have issues with a duplex kidney. A duplex kidney is a congenital condition (present at birth) in which one of your kidneys has two tubes (ureters) that connect to your urinary bladder.

Having a duplex kidney isn’t always bad. In fact, some people may never know they have a duplex kidney. But it can cause issues like:

• Vesicoureteral reflux (VUR). VUR causes urine (pee) to flow backward from your bladder to your kidneys. Over time, this can damage your kidney.
• Ectopic ureter. An ectopic ureter drains pee into a nearby organ instead of your bladder. This can damage the organ.
• Ureterocele. This is when the bottom of your ureter balloons (bulges) as it enters your bladder, which can block your urine flow.

Most people with duplex kidneys and any of these issues typically require monitoring for any other problems and don’t need surgery. If they need surgery, it may not even be a heminephrectomy. Healthcare providers may recommend a heminephrectomy, or another procedure, if part of your kidney stops working because of backflow pressure (VUR) or blockage (ureterocele) and you develop recurring problems (usually infections).

How should I prepare for a heminephrectomy?

Before a heminephrectomy, your surgeon will explain the procedure to you and ask for your consent. They’ll perform a physical exam to ensure you’re healthy enough for surgery. They’ll also ask questions about:

• Your health history
• Any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements; certain medications, such as blood thinners, can increase your risk of bleeding
• Any allergies you have

In the days leading up to your surgery, a healthcare provider will give you specific directions on when to stop taking prescription or OTC medications, if necessary. They’ll also give you instructions on when to stop eating and drinking (fast) before the procedure.

What healthcare providers make up a heminephrectomy team?

A heminephrectomy team typically includes:

• Urologist
• Anesthesiologist
• Nurses

The anesthesiologist will give you general anesthesia so you won’t be awake or feel any pain during the procedure. A nurse or physician will then insert a Foley catheter to drain pee from your bladder.

What happens during a heminephrectomy?

Urologists may perform this procedure either open or through a minimally invasive approach. Minimally invasive approaches include:

• Laparoscopic surgery. A urologist uses a knife (scalpel) to make up several small cuts (incisions) in your abdomen. They insert a thin, telescopic rod with a light and a video camera at the end (laparoscope) into one of the incisions to look at your kidney. They insert other surgical instruments into the other incisions to remove the nonfunctional part of your kidney. Alternative surgeries also exist for this problem.
• Robotic surgery. A urologist performs a similar procedure to a laparoscopic surgery. But instead of directly using their hands, they use a surgical robot to control the instruments.

In some cases, a urologist may need to perform an open heminephrectomy. During an open heminephrectomy, they’ll make one longer incision up to 12 inches (30 centimeters) in your flank. Your flanks are the sides of your body, between your hips and ribs. An open heminephrectomy gives a urologist a better look at your kidney and allows them to use their hands to remove or repair the affected ureter.

How long does a heminephrectomy take?

A heminephrectomy can take up to two to three hours to perform. But this could take longer according to your anatomy.

What happens after a heminephrectomy?

After a heminephrectomy, a healthcare provider will stitch your incisions and cover them with bandages, surgical glue or both. The anesthesiologist will stop giving you anesthesia, and you should be conscious (awake) in a few minutes. But you’ll likely feel very groggy.

Nurses will move you to a recovery room. They’ll wait for you to more fully wake up and monitor your overall health. They’ll also manage your pain.

Once providers determine you’re healthy enough, they’ll let you go home. This may be the same day, or you may need to stay up to a few days. A family member or friend must drive you home.

You may need to follow a special eating plan and avoid certain activities for a few weeks to give your body time to heal.

What are the benefits of a heminephrectomy?

The main benefit of a heminephrectomy is that it removes a problematic and nonfunctional part of a duplex kidney.

What are the risks of a heminephrectomy?

Heminephrectomy complications are rare. But as with any surgery, they may occur. Risks include:

• Blood clots
• Bacterial infection
• Damage to nearby organs, including your intestines (bowels), liver or spleen

What is the recovery time after a heminephrectomy?

It depends on the surgical approach, your health history and any other conditions you have. Your urologist will give you a better idea of what to expect according to your specific case. But in general, shortly after surgery, healthcare providers will encourage you to get out of bed and walk. Walking helps your body recover. It also limits your risk of developing blood clots and prevents pneumonia. Avoid lifting anything heavier than a gallon of water (10 pounds or 4.5 kilograms).

A minimally invasive heminephrectomy takes less time to heal than an open heminephrectomy. Most people can resume their typical activities four to six weeks after a minimally invasive heminephrectomy. It may take eight to 12 weeks to recover after an open heminephrectomy.

When can I go back to work/school after a heminephrectomy?

You should be able to go back to work or school three to four weeks after a heminephrectomy. But if you have a more physically demanding job, you may need more time off.

What should I eat and drink after a heminephrectomy?

A healthcare provider may recommend drinking lots of water (about six to eight glasses each day) and eating well-balanced or soft meals for the first four weeks after a heminephrectomy. This may include:

• Bread and butter
• Canned applesauce, peaches or pears
• Fish
• Mashed potatoes
• Meats without skin casing
• Well-cooked vegetables

You should avoid the following foods until you’re able to poop as normal (normal bowel function):

• Meat and meat substitutes, including meat with casings (like hot dogs and sausage) and luncheon meats
• Fruits, including raw fruits (except bananas), dried fruits (like raisins and prunes), berries, canned fruit cocktail and pineapple
• Raw vegetables
• Dairy
• Grains, including bran cereals, cereals with nuts and coarse whole grains

When should I call a healthcare provider?

Your urologist will schedule follow-up appointments to check on your incisions and stitches as you’re healing. This is usually seven to 10 days after the procedure. But it may be longer, depending on your situation.

Contact a healthcare provider immediately if you have any abnormal symptoms after a heminephrectomy. Abnormal symptoms may include:

• Difficulty breathing
• Heavy bleeding around your stitches
• Your skin pulls away at your stitches
• Signs of infection, including discoloration (red, purple, brown or black), fever, pus/drainage or a bad odor around your incisions
• Increased pain
• Pain in your legs
• Blood in your pee