Nephroureterectomy for malignant kidney tumor in children Medical editor Kristin Bjørnland MD
Oslo University Hospital
Normally, the entire kidney and ureter are removed when there is a malignant tumor in the kidney. If there are tumors in both kidneys, it may be possible to remove only the tumors and preserve enough kidney tissue to avoid dialysis.
- Malignant tumor in the kidney
- Complete removal of cancer tissue
- Pediatric tray
- Vascular tray
Information about the nature of the surgery and its risk should be given by the surgeon. Both parents should be present during this meeting.
The procedure is carried out under general anesthesia. An arterial catheter and urinary catheter will be inserted for the surgery.
The most common access is via a wide, transverse incision. All organs in the abdominal cavity are inspected and palpated to check that there is no tumor tissue outside the kidney. The other kidney should be inspected thoroughly.
- The kidney containing the tumor is dissected.
- The vessels to the kidney are divided as early as possible. The renal artery is usually first taken followed by the renal vein.
- The surgeon then inspects for tumor thromboses in the renal vein and the vena cava. If there are tumor thromboses, they should be removed.
- The kidney is handled carefully to avoid rupture of the tumor with spreading of cancer cells into the abdominal cavity.
- The ureter is divided at the bladder. The adrenal gland on the affected side is usually not removed.
- A drain is not usually installed.
The child is monitored in the postoperative unit or pediatric intensive care unit for the first 24 hours. Heart rhythm, respiration, and renal function are monitored.
The child receives conintuous morphine infusions for pain.
The child is usually discharged from the surgical ward after a few days.