16214 Open Partial Nephrectomy

Overview

An open partial nephrectomy is surgery to remove a small part of one kidney while leaving the rest of that kidney in place. It is also called 'kidney-sparing surgery' or 'nephron-sparing surgery'. 'Open' means the surgeon makes one larger cut (an incision), usually in your side or belly, rather than several small keyhole cuts. The aim is to take out a growth or damaged area and keep as much healthy kidney tissue as possible, so your kidneys keep working well.

Yes. Partial nephrectomy is a common and well-established operation. It has become the usual choice for small kidney tumours whenever it is safe to do so, because leaving more kidney behind is generally better for long-term kidney health.

It is most often done in adults, usually middle-aged or older, who have a small growth in one kidney. It can also be used in younger adults and in people who have only one kidney, or whose other kidney does not work well, because preserving kidney tissue matters even more for them. Sometimes it is done for non-cancer reasons, such as a benign growth, a cyst, or a kidney stone problem.

Symptoms

Common symptoms

• Many people have no symptoms at all — the kidney growth is spotted on a scan done for another reason.
• Blood in the urine (the urine may look pink, red or cola-coloured).
• Pain or a dull ache in the side or lower back.
• A lump or fullness you can feel in the side of the belly.
• Feeling very tired, or losing weight without trying.
• A mild fever or feeling generally unwell that does not settle.

Symptoms in children

• Partial nephrectomy is uncommon in children. When it is considered, it is usually for a specific kidney problem found by a specialist children's team.
• Children may show a swelling in the belly, blood in the urine, or poor feeding and tiredness.
• A child's care is always planned by a specialist children's kidney or surgical team.

Symptoms in older adults

• Older adults may have no symptoms and the growth may be found during a routine scan.
• Other health conditions, such as heart or lung problems, are carefully reviewed before surgery.
• Some older adults may be offered close monitoring (surveillance) instead of an operation, depending on the size of the growth and their overall health.
• Recovery may take a little longer, and planning for help at home after surgery is very useful.

Causes

Main causes

• A small tumour in one kidney — many kidney tumours are found early and are small enough to remove only the affected part.
• A harmless (benign) growth or cyst that is causing problems or is hard to tell apart from a tumour.
• Damage to part of a kidney from repeated infections, scarring, or stones.
• In some people, an inherited condition that raises the chance of kidney growths.

Risk factors

• Smoking.
• Being overweight.
• High blood pressure.
• Long-term kidney disease or dialysis.
• A family history of kidney tumours, or certain inherited conditions.
• Age — kidney tumours become more common as people get older.
• Some workplace chemical exposures, though this is less common.

When to see a doctor

See a doctor urgently if:

• You notice blood in your urine.
• You have pain in your side or back that keeps coming back or is getting worse.
• You feel a lump or swelling in your belly or side.
• You have a high temperature with pain in your side or problems passing urine after surgery.
• Your wound starts leaking, becomes very red, or you feel very unwell after going home.

Book a routine appointment if:

• You have been told you have a small kidney growth and want to talk through your options.
• You have a family history of kidney tumours and want advice about checks.
• You are unsure what to expect before or after kidney surgery.
• You have questions about returning to work, driving, or exercise after your operation.

Diagnosis

The problem is usually first spotted on a scan, often one done for another reason. Your doctor will then arrange more detailed imaging to see the size and position of the growth and how well your kidneys are working. Sometimes a small sample of tissue (a biopsy) is taken with a thin needle to check what the growth is. Your team will also review your general health to decide whether surgery is the best option for you.

Tests that may be done

• Blood tests, including a test of how well your kidneys are filtering (kidney function tests).
• A urine test to check for blood or infection.
• CT or MRI scans of your kidneys and tummy area.
• An ultrasound scan in some cases.
• A needle biopsy of the growth, if your team thinks it will help.
• A review of your heart and lungs (such as an ECG and chest X-ray) before a general anaesthetic.
• A meeting with the anaesthetic team to plan your pain relief and safety during surgery.

What to expect at your appointment

Before surgery you will have a pre-assessment appointment, usually a week or two beforehand. You may be asked not to eat or drink for several hours before the operation. You will be given clear instructions about which of your regular medicines to take — always ask your team or pharmacist rather than deciding yourself. On the day, you will meet the surgeon and anaesthetist, and you can ask any last questions before you go to sleep.

Treatment

Treatment depends on the size and position of the growth, whether it looks likely to be cancer, your age, your other health conditions, and how well your kidneys work. Options include watching the growth with regular scans (surveillance), removing just the affected part of the kidney (partial nephrectomy), destroying the growth with heat or cold using a thin probe (ablation), or, less often, removing the whole kidney. Your team will discuss the pros and cons of each with you so you can choose what suits you.

Self-care at home

• Follow your team's instructions about eating, drinking and medicines before surgery — and ask your pharmacist if anything is unclear.
• Arrange help at home for the first couple of weeks after you leave hospital.
• Keep gently active after surgery — short walks help your circulation — but avoid heavy lifting, straining, and vigorous exercise until you are told it is safe.
• Drink plenty of water each day unless your team advises otherwise.
• Keep the wound clean and dry, and follow the dressing advice you are given.
• Ask your doctor or pharmacist before taking any painkiller or supplement, because some can be hard on the kidneys.
• Attend your follow-up appointments and any scans your team recommends.

Medical treatments

There is no medicine that removes a kidney growth. Some people are monitored with regular scans instead of having an operation, especially if the growth is small and slow-growing. If the growth turns out to be a cancer, your team may discuss additional treatments after surgery, such as medicines that support the immune system or targeted treatments, depending on the exact type and stage. These decisions are always made with a specialist team and explained to you in detail.

When is surgery considered?

Surgery is usually suggested when the growth is small enough to remove while keeping a good amount of healthy kidney, and when you are well enough for an anaesthetic. It is often favoured when you have only one kidney, or your other kidney does not work well, because saving kidney tissue matters most. Your team may advise monitoring instead if the growth is very small, growing slowly, or if surgery would carry more risk than benefit for you.

Living with this condition

Most people go home within a few days of surgery and feel steadily better over the following weeks. You will have a wound in your side or belly, and you may have a small drainage tube and a urinary catheter for a short time. Tiredness is common at first, so plan short activities with rests in between. Many people return to lighter work within 4 to 6 weeks, but this varies — ask your surgeon what is realistic for you. Driving is usually possible once you can sit comfortably and react quickly, often after a few weeks; check with your team and your car insurer.

Lifestyle tips

• Stop smoking if you smoke — this is one of the best things you can do for your kidney and heart health.
• Keep to a healthy weight through balanced meals and regular gentle activity.
• Stay well hydrated, especially in hot weather or when exercising.
• Keep blood pressure in a healthy range, and have it checked regularly.
• Avoid long periods without moving during the first weeks after surgery, to help prevent blood clots.
• Be careful with over-the-counter painkillers — ask your pharmacist which are gentlest on the kidneys.
• Go to all follow-up scans so any changes are picked up early.

Diet and exercise

You do not need a special diet after a partial nephrectomy, but eating well helps recovery. Aim for plenty of vegetables, fruit, wholegrains and lean protein, and go easy on very salty and highly processed foods. Drink water regularly through the day. Once your wound has healed and your team agrees, build up activity gradually — walking first, then swimming or cycling, then your usual exercise. Avoid contact sports, heavy lifting and core workouts until you are given the go-ahead, usually after about 6 weeks.

Mental health and emotional wellbeing

It is very normal to feel anxious before and after kidney surgery, and to worry about scans and results. Some people feel low for a while, or find it hard to concentrate. These feelings usually ease as you recover, but you do not have to cope alone. Talking to family, friends, your GP, or a counsellor can help a great deal. If low mood, worry or sleep problems last more than a couple of weeks or affect your daily life, please reach out for support — you deserve it.

Prevention

Not all kidney growths can be prevented, but you can lower your risk. Not smoking, keeping to a healthy weight, eating well, staying active and keeping blood pressure in a healthy range all support kidney health. If you have a strong family history of kidney tumours or an inherited condition, talk to your doctor about whether regular checks are right for you.

Screening programmes

There is no routine national screening programme for kidney tumours. Most small kidney growths are found by chance on scans done for other reasons. If you have an inherited condition that raises your risk, your specialist team may recommend regular scans — ask them what applies to you.

Complications

If left untreated

• A kidney tumour may grow larger over time and could spread to other parts of the body.
• A large growth may become harder to remove while sparing the kidney.
• Some people develop blood in the urine, pain, or reduced kidney function.
• Non-cancer problems, such as repeated infections or stones, may keep causing symptoms.

Long-term outlook

Most people recover well after an open partial nephrectomy. Because the surgeon keeps as much healthy kidney as possible, kidney function is usually well preserved, and many people live full, active lives afterwards. As with any operation, there are risks — such as bleeding, infection, a urine leak, or a change in kidney function — and your team will explain these to you. You will have follow-up scans to keep an eye on things, and any questions along the way are always worth raising with your care team.

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