Recovery After
Robotic Nephroureterectomy

This operation removes the kidney, the whole ureter and a small cuff of the bladder where the ureter joins it. Recovery is similar to other robotic kidney surgery, with one addition: a catheter stays in place to let the bladder repair heal.

You will be helped out of bed on the day of surgery, and eating and drinking usually restart quickly. A drain near the kidney is removed once its output settles. Most people go home after one to two nights, with the catheter still in.

Cells from an upper tract tumour can settle in the bladder during or after surgery. A single dose of chemotherapy is instilled into the bladder a few days after surgery, usually when the catheter is removed, which lowers that risk.

In a randomised trial, a single dose of chemotherapy into the bladder reduced bladder tumours in the first year after nephroureterectomy from 27% to 17%.

The catheter usually stays in for around 7 days while the bladder cuff heals. It is removed at a clinic appointment, sometimes after an X-ray test that confirms the repair is watertight.

Some stinging and a little blood in the urine are common in the first day or two after removal, as is needing to pass urine more often for a short while.

Tiredness is usual, and daytime naps are normal at first. Walk every day and increase gradually.

• keep the wound sites clean and dry; showering is usually fine once the dressings are off
• avoid heavy lifting and strenuous exercise for about four to six weeks
• avoid driving for about two weeks, and until you could make an emergency stop comfortably
• desk work is usually possible within two to three weeks, physical work later
• a gentle laxative helps the constipation that often follows an anaesthetic

One kidney has been removed, so overall kidney function is lower than before. The remaining kidney usually compensates well. A blood test a few weeks after surgery shows where your function sits, and it is checked periodically afterwards.

Keep well hydrated, have your blood pressure checked, use anti-inflammatory painkillers sparingly, and tell any doctor prescribing for you that you have one kidney. Kidney function also affects whether certain chemotherapy drugs can be used, which is one reason it is measured before any further treatment is planned.

After this operation, regular bladder checks by cystoscopy are essential, because bladder tumours develop in a significant proportion of patients afterwards. The first check is usually at about three months, and the schedule then continues for several years alongside scans of the remaining kidney and ureter.

Contact the clinic, or go to the Emergency Department at Subang Jaya Medical Centre if it is outside working hours, if you have:

• the catheter stops draining, or you cannot pass urine after it is removed
• fever, shivering or feeling generally unwell
• heavy blood in the urine, or clots
• worsening pain in the abdomen or flank
• a wound that is red, hot, swollen or leaking fluid
• calf pain or swelling, chest pain or breathlessness