Nephrectomy Flashcards
Define nephrectomy.
Removal of the kidney only
Ureter ligated close to kidney
Define ureteronephrectomy (or nephroureterectomy).
Removal of the kidney and majority of the ureter
Ureter ligated close to bladder
Define partial nephrectomy.
Removal of part of the kidney
Uncommonly performed in vet med
What are the indications for ureteronephrectomy?
The risk of leaving the kidney in the body should be greater than the risk of removing it
The remaining kidney must be able to maintain homeostasis
Irreparable trauma
Neoplasia - full staging is important (not lymphoma)
Severe hydronephrosis? - consider azotemia (will get worse if kidney gets taken out), obstruction, underlying cause
Infection
What is the minimum pre-op planning?
Complete bloodwork and UA
Abdominal imaging
Blood type in some situations
What is the worry with renal azotemia?
Much less likely to tolerate nephrectomy, especially if the kidney to be removed still has function
Cannot blame renal azotemia on 1 kidney
How can you obtain single kidney GFR?
Nuclear scintigraphy
Limited availability
Delay surgery due to radioactivity
What are the steps of surgery to remove a kidney?
Long ventral midline incision
Free the kidney from the retroperitoneum
Retract the kidney ventromedially
Want to ligate the artery first - kidney will fill with blood fast if vein is first
Do not ligate the artery and vein together
Watch for branches
Follow the ureter from the kidney to the bladder
Ligate the ureter at the level of the urinary bladder
Leave the smallest ureteral remanent possible
What ureter issue is common in cats to be aware of in surgery?
Circumcaval ureter
What are post-op considerations?
Maintain GFR in the remaining kidney - fluids, no NSAIDs, blood pressure monitoring
Monitor kidney values
Monitor PCV in the immediate post-op period
What are the complications?
Renal failure
Hemorrhage
Incisional complications
