A nephrotomy is a surgical procedure that cuts into the kidney. This shouldn’t be confused with a nephrectomy, where the kidney is removed, or a nephrostomy, where a hole is created in the kidney for drainage. There are several reasons why a surgeon might recommend this as part of a course of treatment for a patient, and it may be combined with other treatments to address an issue like kidney stones. Recovery time can depend on the reason for the procedure.
Historically, the nephrotomy was a procedure of last resort for kidney stones. If patients couldn’t pass the stones on their own, a surgeon could cut directly into the kidney to remove them. Today, a number of options including inserting a catheter and entering the kidney that way may be considered before cutting into the organ. These are less invasive and can generate fewer side effects, in addition to keeping the patient more comfortable. There may be extreme cases where it is still necessary to access the kidney with a nephrotomy.
This procedure can also be used to cut into the kidney for the purpose of draining and treating an abscess. In this case, the goal is to remove infected material to prevent tissue death and limit swelling. A temporary drain may be inserted so that as pus and other materials build up, they have a route to escape. Unlike a nephrostomy, the goal is not to provide a medium to long-range drainage hole for the kidney, as might be necessary for patients with urological cancers and other conditions that inhibit normal kidney drainage.
Before a surgeon will perform a nephrotomy, the patient is carefully screened for any risk factors that might need to be considered in the operating room. These can include allergies to anesthetics, an underlying infection, or cardiovascular disease. In surgery, the doctor may be able to make a laparoscopic incision to access the organ, or an open incision might be required to expose the area. After making the cut and resolving the problem, the surgeon can stitch it back up and bandage the wound so the patient can be moved to recovery.
Abdominal pain and soreness can be common after a nephrotomy, and patients may notice cloudy or bloody urine for several days as the organ heals. Antibiotic medications may be recommended as prophylaxis to prevent infections and the patient can be monitored for signs of complications. Indicators of a problem can include extreme abdominal tenderness, difficulty urinating, and changes in blood chemistry that suggest the kidney may be failing.