Complete removal of a kidney and the entire length of its ureter, performed robotically for cancers arising in the renal pelvis or ureter (upper tract urothelial carcinoma).
Upper tract urothelial carcinoma (UTUC) is cancer arising in the lining of the kidney’s collecting system (renal pelvis) or the ureter — the tube connecting the kidney to the bladder. Because this cancer can spread along the entire length of the urinary lining, the standard of care is removal of the kidney and the complete ureter, including a small cuff of bladder where the ureter inserts.
This procedure can be performed entirely robotically in a single-step approach — meaning no repositioning or separate incision is required for the bladder cuff excision. This can reduce operative time and blood loss, and has been associated with shorter hospital stays.
Lymph nodes near the kidney and ureter may be removed (lymphadenectomy) to help with staging and, in some cases, treatment.
02
Before your procedure
Pre-operative assessment including blood tests, kidney function, and CT imaging review.
Neoadjuvant systemic therapy may be recommended before surgery for high-risk cases — this will be discussed at your consultation.
Fast for six hours before surgery. Blood-thinning medications should be stopped as directed.
Arrange for support at home for at least the first week after discharge.
03
Risks and benefits
Treatment with curative intent
Removing the kidney, ureter and a small cuff of bladder is the standard treatment for high-risk localised upper tract urothelial cancer.
Complete removal in one operation
The kidney and the whole ureter are removed together, lowering the chance of cancer returning in a remaining section of ureter.
Quicker recovery
Compared with open surgery, robotic surgery is generally associated with less blood loss and a shorter hospital stay.
Expected
Reduced kidney function
Removing a kidney reduces total kidney function. The remaining kidney typically compensates well, but regular monitoring is important, particularly if the remaining kidney is already compromised.
Common
Pain and fatigue
Post-operative discomfort is managed with prescribed pain relief and usually resolves significantly within 1–2 weeks.
Uncommon
Bleeding
Blood transfusion is required in a small minority of cases. Robotic surgery reduces blood loss compared to open surgery.
Uncommon
Urine leak or bladder symptoms
The bladder repair site can occasionally leak, requiring extended catheter drainage. Some patients experience urinary urgency in the weeks after the bladder cuff is repaired.
Uncommon
Bladder recurrence
Bladder tumours can develop after nephroureterectomy in a significant proportion of patients, so regular cystoscopy surveillance is essential after surgery.
Rare
Injury to adjacent structures
Injury to nearby bowel, blood vessels, or the contralateral ureter is rare. Conversion to open surgery may occasionally be necessary.
04
Aftercare and recovery
1
Catheter and drain
A urinary catheter is typically in place for around 7 days to allow the bladder cuff repair to heal. A drain near the kidney may also be placed and removed before discharge.
2
Return to activity
Light walking from day one. Avoid driving for 2 weeks and strenuous activity for 4–6 weeks. Return to desk work is usually possible within 2–3 weeks.
3
Bladder surveillance
Cystoscopy surveillance of the bladder is essential after this operation and will be arranged at 3 months, then at regular intervals. Bladder recurrence is common and early detection is important.
4
Oncological follow-up
CT scans and kidney function blood tests are performed at regular intervals. A structured follow-up schedule will be provided at discharge.
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Disclaimer
This information is for general education and is not a substitute for personal medical advice.
Content adapted from the British Association of Urological Surgeons (BAUS) and the American Urological Association (AUA) patient information resources.