ANATOMICAL REVIEW

The kidney is an organ that plays the role of a filter participating in the purification of the blood and the elimination of waste from the body.

The kidneys are usually two in number. They are located in the abdomen under the thorax, on either side of the spine. Urine produced by the kidneys is drained through the ureters to the bladder where it is stored between urinations.A single kidney can be enough to ensure this purification function.

WHY THIS INTERVENTION?

The tests requested by your doctor revealed a kidney tumor.

The size of the tumor and its location make it possible to consider preserving part of the kidney; therefore, the surgical treatment offered to you consists of removing the part of the kidney where the tumor is located.This operation is necessary because, in the absence of treatment, this tumor exposes you to the risk of progression of the tumor disease (pain, bleeding, fever, chemotherapy, metastases, death).

ARE THERE OTHER POSSIBILITIES?

Some small tumors can simply be monitored.For others, an alternative to surgical treatment exists. These are so-called ablative techniques, which consist of destroying the tumor by applying cold (cryotherapy) or heat (radiofrequency, microwaves). Other focused radiotherapy techniques may be proposed.However, these techniques which do not carry out tumor excision are reserved for specific indications.Your urologist has explained to you why he is offering you a partial nephrectomy/lumpectomy.

PREPARATION FOR INTERVENTION

Any surgical procedure requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed.Before each surgical procedure, a pre-operative anesthesia consultation is mandatory.It is imperative to inform your urologist and the anesthesiologist of your medical, surgical and allergic history and your current treatments, in particular oral or injectable anticoagulants or antiplatelet agents (aspirin, clopidogrel, anti-vitamin K, etc.). Their use increases the risk of bleeding during the procedure. This treatment may be adapted and possibly modified before the intervention.

OPERATIVE TECHNIQUE

The procedure takes place under general anesthesia.Several approaches provide access to the kidney:

• A classic incision anterior or on the side of the abdomen (lumbotomy)
• A laparoscopic approach with or without robotic assistance

The choice is made according to the location of the tumor, your morphology, your history and the habits of your surgeon.It is possible :

• That a probe be placed in the ureter during the intervention,
• That the approach be modified during the procedure due to difficulties.

The surgical procedure consists of removing the tumor while preserving the healthy part of the kidney. In most cases, the blood circulation of the kidney must be temporarily interrupted by clamping (temporary occlusion of the kidney vessels), while the tumor is removed.At the end of the procedure, drains can be put in place. They make it possible to monitor flow from the surgical site.The surgical piece, removed during the operation, is secondarily analyzed under a microscope during the anatomopathological examination. This examination is important to decide on the follow-up to be given to your illness: monitoring, surgical revision, chemotherapy, etc.

USUAL FOLLOW-UP

To monitor the proper functioning of the kidneys and prevent you from having urinary difficulties when you wake up, a urinary catheter may be placed during the procedure. This probe may be responsible for discomfort.Post-operative pain is managed by administering analgesics. A catheter can be placed in the scar to reduce the pain in the first few hours.You are usually allowed to get up and eat again early.Removal of the drain(s) and urinary catheter is defined by the surgeon. These ablations are only exceptionally painful.The length of hospitalization varies and a convalescence of a few weeks is necessary.You will discuss with your surgeon the date of resuming your activities and the follow-up after the operation.

RISKS AND COMPLICATIONS

In the majority of cases, the intervention offered to you takes place without complications. However, any surgical procedure carries a certain number of risks and complications described below.Some complications are linked to your general condition.Any intervention

PARTIAL NEPHRECTOMY / TUMORECTOMY FOR TUMOR

The kidney is an organ that plays the role of a filter participating in the purification of the blood and the elimination of waste from the body.The kidneys are usually two in number. They are located in the abdomen under the thorax, on either side of the spine. Urine produced by the kidneys is drained through the ureters to the bladder where it is stored between urinations.A single kidney can be enough to ensure this purification function.

WHY THIS INTERVENTION?

The tests requested by your doctor revealed a kidney tumor.The size of the tumor and its location make it possible to consider preserving part of the kidney; therefore, the surgical treatment offered to you consists of removing the part of the kidney where the tumor is located.This operation is necessary because, in the absence of treatment, this tumor exposes you to the risk of progression of the tumor disease (pain, bleeding, fever, chemotherapy, metastases, death).

ARE THERE OTHER POSSIBILITIES?

Some small tumors can simply be monitored.For others, an alternative to surgical treatment exists. These are so-called ablative techniques, which consist of destroying the tumor by applying cold (cryotherapy) or heat (radiofrequency, microwaves). Other focused radiotherapy techniques may be proposed.However, these techniques which do not carry out tumor excision are reserved for specific indications.Your urologist has explained to you why he is offering you a partial nephrectomy/lumpectomy.

PREPARATION FOR INTERVENTION

Any surgical procedure requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed.Before each surgical procedure, a pre-operative anesthesia consultation is mandatory.It is imperative to inform your urologist and the anesthesiologist of your medical, surgical and allergic history and your current treatments, in particular oral or injectable anticoagulants or antiplatelet agents (aspirin, clopidogrel, anti-vitamin K, etc.). Their use increases the risk of bleeding during the procedure. This treatment may be adapted and possibly modified before the intervention.

OPERATIVE TECHNIQUE

The procedure takes place under general anesthesia.Several approaches provide access to the kidney:

• A classic incision anterior or on the side of the abdomen (lumbotomy)
• A laparoscopic approach with or without robotic assistance

The choice is made according to the location of the tumor, your morphology, your history and the habits of your surgeon.It is possible :

• That a probe be placed in the ureter during the intervention,
• That the approach be modified during the procedure due to difficulties.

The surgical procedure consists of removing the tumor while preserving the healthy part of the kidney. In most cases, the blood circulation of the kidney must be temporarily interrupted by clamping (temporary occlusion of the kidney vessels), while the tumor is removed.At the end of the procedure, drains can be put in place. They make it possible to monitor flow from the surgical site.The surgical piece, removed during the operation, is secondarily analyzed under a microscope during the anatomopathological examination. This examination is important to decide on the follow-up to be given to your illness: monitoring, surgical revision, chemotherapy, etc.

_ USUAL FOLLOW-UP

To monitor the proper functioning of the kidneys and prevent you from having urinary difficulties when you wake up, a urinary catheter may be placed during the procedure. This probe may be responsible for discomfort.Post-operative pain is managed by administering analgesics. A catheter can be placed in the scar to reduce the pain in the first few hours.You are usually allowed to get up and eat again early.Removal of the drain(s) and urinary catheter is defined by the surgeon. These ablations are only exceptionally painful.The length of hospitalization varies and a convalescence of a few weeks is necessary.You will discuss with your surgeon the date of resuming your activities and the follow-up after the operation.

RISKS AND COMPLICATIONS

In the majority of cases, the intervention offered to you takes place without complications. However, any surgical procedure carries a certain number of risks and complications described below.Some complications are linked to your general condition.Any intervention

lmonaries, pulmonary embolisms,strokes, phlebitis,myocardial infarctions, the forms of which are the mostmore severe ones can lead to death.

• Skin or neurological problems linked toyour position on the operating table orprolonged bed rest which can lead toafter-effects and long-term management.
• More or less severe infections:
• Urinary infection related to treatmentantibiotic.
• General infection with septicemia which mayrequire intensive care.
• Infection of the wall and scarwhich may justify prolonged local care.
• Urinary complications: poor drainageurine (fistula, obstruction).
• Lymphatic flow which can sometimeslead to re-intervention.
• Appearance of an abdominal collection orpelvis which may require placementof an evacuation drain or a newintervention.
• Digestive complications:
• Delay in resuming intestinal transit ortrue intestinal obstruction.
• Digestive fistula (by loosening of suturesintestinal) usually requiringre-intervention.
• Evisceration with the need for reintervention.
• Stomach ulcer most oftenprolonged medical treatment.
• Digestive complications:
• Eventration of the wall of the abdomen.
• Intestinal obstruction by adhesionsintra-abdominal (bridles).
• Urinary complications:
• A narrowing (stenosis) may occurproduce at the suture betweenthe intestine and the urinary ducts (ureter orurethra).
• Dilation of the intestinal bladder with riskurine retention, stones, alterationkidney function or ruptureof the neobladder.
• Wall complications:
• Eventration around a stoma opening orhernia of a stoma causing difficultyof equipment.
• Skin problems around the stoma(irritation, calcifications) requiring treatmentlocal and rarely a new intervention.
• Appearance of an abdominal collection orpelvis which may require placementof an evacuation drain or a newintervention.
• Diarrhea, vitamin deficiency, linked toshortening of your small intestine andrequiring prolonged treatment.
• Risks linked to cancer: progressive recoveryjustifying new treatments. Side effects related to your bypassurinary and sexual effects
• If you carry an external bag ofcollection of urine, this can from time to timetime to flee. An adaptation of the materialostomy usually solves the problemeasily.
• If you have had a bladder replacement,it is rare that you are immediatelycontinent. During the day, the leaks almostmandatory at the time of removal of theprobe will generally decrease quitequickly. At night, complete continenceis often difficult to obtain and can sometimesrequire regular lifting. For thesecontinence problems, you may behelped by specific rehabilitation.Conversely, emptying this new tankbladder is frequently incomplete (byaccumulation of mucus), which can lead tourinary infections, stones and mayjustify intermittent surveys. Sometimes thesesurveys prove difficult to carry out. Aspecific supervision may be put in placeto help you.
• The problems that arise from thechanging your body image(sexual problems, depression, etc.) maybe subject to specific treatment.
• Removal of the anterior part of the vaginamay cause discomfort whensexual intercourse (pain, irritation, etc.). Of thelocal treatments may be offeredto improve your sexuality.

If an internal tank is used, it maybe necessary to drink alkaline water (typeVichy water) to compensate for the acidity of the urine.It is normal to notice the presence of mucusin urine, or even intestinal germs which do notdo not necessarily justify the start-upof antibiotic treatment.You are informed by your urologist or bythrough your driving doctormaintain and subsequent monitoring. A follow-up ofseveral years is most often necessary. Heaims to verify the absence of recurrencecancer and the proper functioning of yoururinary system.Monitoring of renal function is planned.The resumption of your activities will begradually depending on the advice givenduring your hospitalization and by yourdoctor.Here are some tips for post follow-upsoperational: Prevention of phlebitis and embolismpulmonaryBed rest and lack of movement of thelower limbs promote venous stasis.Pain in one leg, feeling ofgravity or a reduction in the sloshing of thecalf should suggest phlebitis. He istherefore necessary to consult a doctoremergency.In order to avoid the occurrenceof phlebitis, he isadvised to follow the recommendations that youwere given: regular contractions andfrequent calf movements, foot movements,elevation of the legs and following the prescriptionfrom your doctor, wearing compression stockings.In case of chest pain, side stitch,irritating cough or shortness of breath, it isnecessary to consult urgently because these signsmay be indicative of an embolismpulmonary. Contact us immediatelyyour doctor or emergency departmentcloser by calling Center 15. HealingAbdominal surgery involves one orseveral incisions of varying size. Theseincisions are not only areas ofweakness, but also doors of entrypossible for infection. It is thereforenecessary to ensure good hygienelocal. If the scar becomes red or hot orif there is an elevation of this, it isimportant to show this scar, withoutemergency, to your surgeon: this may be ahematoma or abscess.Skin healing occurs in severaldays. During this period, it may occura little bleeding that can be stopped bycompressing using a gauze or aclean laundry. Removal of wires or staples iscarried out in hospital or by a nursehome following medical prescriptionexit.Disunion of the skin can sometimes occur. Ifthis opening is superficial, it is necessarysimply wait for it to close, the delayclosure can reach several weeks(especially in diabetic patients or those undercorticoid). If you feel a crunchdeep scar or deep disunity,it is necessary to quickly consult yoursurgeon.Tobacco and malnutrition slow down thehealing. Disorders of intestinal transitAfter abdominal surgery, the return to transitperfectly normal digestive tract may requirea few weeks. Transit disorders arefrequent. A period of several days withoutstool is not a worrying sign. At the opposite,absence of gas, nausea orvomiting requires a consultationemergency (risk of occlusion).

To facilitate the resumption of normal transit, itis advised to:

• Eat small amounts everymeal while chewing slowly
• Eat meals seated, in peace
• Stop eating as soon as possibledigestive tightness
• Do not drink too much while eating, but drinkenough between meals
• Eat balanced and as varied as possibleto avoid nutritional deficiencies
• Respect a sufficient protein intake(meat, eggs, fish, dairy products, etc.)
• Avoid excessive consumption of carbonated drinks,sauces and fried foods, as well as sweetsand fatty foods.

SIGNS THAT MAYOCCURRING AND CONDUCTTO HOLD

A feverAn unexplained fever (> 38°) may berelated to a urinary infection, withinfection of the surgical site or with anotherpost-operative complication. It is necessaryunder these conditions that you consult yourdoctor or your urologist who will carry out thenecessary examinations and will judge the attitude toadopt.

Progressive swelling of one leg,progressive feeling of heaviness inthe abdomen (or small pelvis)The intervention included the removal ofpelvic lymph nodes. This interruption ofdrainage of lymph may be responsiblea flow of lymphatic fluid intoabdomen (lymphocele) and compressionfrom a vein or other organ. You have tonotify your urologist of this situation tothat he undertakes appropriate explorations.

Abdominal painYou have had an abdominal procedure, itresults from adhesions between differentsegments of the digestive tract. At a further distanceor less close to the intervention, theseadhesions may be responsible forintestinal obstruction due to sudden cessation of transitdigestive. This results in painabdominal pain, usually spasms,accompanied by a cessation of gas emission andstools, sometimes preceded by diarrhea. Thissituation requires that you consult inemergency so that appropriate treatment is available to youprovided (aspiration of the stomach and ifnecessary, surgical intervention to releaseintestine).

Sexual disordersYour sexuality is changed by the intervention.Several elements contribute to it, the traumapsychological linked to cancer and the presenceof an external urinary diversion, and leakspossible urinary in the case of neobladder. HeIt is important to discuss this with yoururologist so that he can help you find asatisfying sexuality.Practical questions

• How can I wash myself?As soon as you return home you cantake a shower but bathing is not allowedonly a month.
• Can I do sports?Resumption of your sporting activities is possiblegradually after a month of rest.
• Can I drive after the procedure?Certain pain medicationscan cause drowsiness which may notnot be compatible with driving.
• Can I travel?Unless otherwise advised by your doctor,trips are possible from the secondmonth postoperative.
• When can I resume activitysexual?Resumption of sexual activity is possibleas soon as your general condition permits. A takespecific charge may be requested fromyour urologist.Certain events require you to consultwithout delay: fever above 38°5, malaise,calf pain, difficulty breathing,difficulty urinating, appearance of blood in theurine, abdominal pain, vomiting,blockage of urine with feeling of bademptying the tank.