Radical nephrectomy, partial nephrectomy (NSS - nephron sparing surgery), and nephroureterectomy are surgical procedures performed on patients diagnosed with a tumour in the kidney, renal pelvis or ureter. Surgical treatment is, in this case, the gold standard and the most effective way of treating kidney cancer, and cancer of the renal pelvis and ureter. Depending on the stage of the disease, the urologist excises the whole kidney or just the tumour, sparing remaining part of the organ, or both the kidney and the ureter.
What is a radical nephrectomy/ partial nephrectomy (NSS- nephron-sparing surgery)/ nephroureterectomy?
Radical nephrectomy, an excision of the whole kidney, is performed on patients with a kidney tumour diagnosis in cases when the tumour is larger than 7cm, it’s localisation or other factors make it impossible to perform a partial nephrectomy. Nephron sparing surgery is performed on patients with stage T1 disease, that is with a tumour that in it’s largest dimension doesn’t exceed 7cm. An additional condition allowing the urologist to perform a partial nephrectomy is appropriate tumour location. Nephroureterectomy is a surgery performed on patients with a renal pelvis tumour and/or a tumour in the ureter. In this procedure, apart from removing the kidney, the urologist also excises the ureter, usually in it’s entirety.
What’s the goal of the surgery?
The goal of surgical treatment is completely curing the patient and preventing the spread of the disease through metastases. Excising the tumour, kidney (with or without ureter) are the only methods allowing to radically cure a patient from kidney cancer.
How does radical nephrectomy/partial nephrectomy look like?
Before undergoing the surgery the patient must go through the necessary imaging and/or endoscopic studies allowing for appropriate evaluation of the disease and qualifying for either radical nephrectomy, nephron sparing surgery, or nephroureterectomy. Then, the patient is admitted to the hospital a day before the surgery and is prepared for the procedure by performing laboratory tests, a physical examination and a pre-operative anaesthesia consultation. The surgery lasts about 2 to 3 hours and is performed in general anaesthesia. During the surgery, the patient lays on his/her side or back, exposing abdomen on the side of the sick organ. The urologist makes a cut below the rib arch getting access to perirenal space. After preparing the organ, the urologist either excises the whole organ, performs a partial nephrectomy, or removes the organ and ureter.
Who is radical nephrectomy/nephroureterectomy for?
Radical nephrectomy is for patients with a kidney tumour bigger than 7cm or a kidney tumour placed in a location that makes it impossible to excise just the tumour. In cases of a tumour located in the system collecting urine from the kidney, renal pelvis and/or ureter, the ureter is also removed.
Who is nephron sparing surgery for?
Nephron sparing surgery (partial nephrectomy) is for patients with a kidney tumour with stage not higher than T1. It means, that the tumour doesn’t exceed 7cm in any dimension and is placed in a location that allows for sparing the rest of the kidney.
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