This page explains about a nephrectomy and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this procedure.
What is a nephrectomy?
A nephrectomy is an operation to remove a kidney. Your child will have this operation under a general anaesthetic and will generally need to stay in hospital for one to two days.
How does the urinary system work?
The urinary system consists of the kidneys, the bladder and ureters. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys down through the ureters to the bladder. From here it passes through another tube called the urethra to the outside when urinating (peeing).
Why does my child need to have this operation?
Your child will need this operation because a kidney is not working properly. This could cause infections which may damage the other kidney, and makes it more likely that your child will have high blood pressure at some point in their life. Being left with one kidney should not cause your child any problems.
What happens before the nephrectomy?
You will already have received information about how to prepare your child for the operation and your admission letter.
The surgeon will explain the operation in more detail, discuss any worries you may have and ask you to sign a consent form. An anaesthetist will also visit you to explain about the anaesthetic.
If your child has any medical problems, particularly allergies, please tell the doctors about these. Please also bring in any medicines your child is currently taking.
What does the operation involve?
In most cases, your surgeon will remove the kidney using keyhole surgery (laparoscopically) but sometimes traditional 'open' surgery may be more appropriate. Open surgery tends to be used if the kidney is very large or badly infected.
In keyhole surgery, the surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) into the abdomen. The kidney is removed through one of these small incisions. After the operation, these small incisions are closed with Steri-strips®.
In traditional open surgery, the surgeon will make an incision (cut) in your child's side and remove the kidney this way. This incision will be closed using dissolvable stitches covered with Steri-strips®.
Whichever method is used, the surgeon will tie off the blood vessels and remove the kidney through the incision. The operation takes between one-and-a-half and two hours.
What happens after the operation?
Your child will be brought back to the ward to recover. He or she will be able to eat and drink soon after the operation. Your child may have a tube (catheter) coming out of the bladder to drain away urine. This is usually removed two days after the operation and then you will be able to go home.
What are the risks of a nephrectomy?
All the surgeons who perform nephrectomies are specialists in the field, have had lots of experience and will minimise the chance of any risks.
There is a chance that keyhole surgery will not be possible for your child. Sometimes the surgeon will not be able to carry out an operation using the keyhole method for technical reasons, or because of unexpected findings. If this is the case, the surgeon will carry out the operation using a larger incision (cut) instead.
All surgery carries a small risk of bleeding during or after the operation. Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any complications.
After an anaesthetic some children may feel sick and vomit. They may have a headache, sore throat or feel dizzy. These side effects are usually short-lived and not severe.
There is a risk that the bleeding can occur when the surgeon removes the kidney. Usually, there is only a small amount of bleeding, but occasionally a child may need to be given extra blood in the form of a transfusion.
The ureter (tube from the kidney to the bladder) is not always removed completely. Occasionally this can cause infections later. If this happens, the rest of the tube may need to be removed.
When you get home:
- You should encourage, but not force, your child to drink.
- Your child may need some pain relief when you get home. Usually paracetamol will enough to relieve any pain if you give it every four to six hours for the next day. You do not need to wake your child during the night to give the medicine. If your child needs stronger medicine, we will give you some before you go home. If when you get home you feel that your child needs more powerful pain relief medicines, you should call your family doctor (GP).
- Your child should not have a bath or shower until a scab has formed over the wound site. When a scab has formed, try to avoid long baths as this may cause the scab to soften and fall off too early.
- The wound site will be closed with Steri-strips®. These usually fall off of their own accord. If they have not fallen off within a week, you can soak them off using a wet flannel.
- Your child’s surgeon will want to see you around three months after the operation to check on your child’s progress. This outpatients appointment will be sent to you at home.
- Your child should return to school when he or she is feeling well again, but should avoid contact sports until after the outpatient appointment.
You should call the ward or your family doctor (GP) if:
- your child is in a lot of pain and pain relief does not seem to help;
- the wound site looks red, inflamed and feels hotter than the surrounding skin;
- there is any oozing from the wound;
- your child has a lot of blood in his or her urine.
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.