What is included in preoperative evaluation for radical nephrectomy?

Updated: Feb 05, 2019
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
  • Print
Answer

In addition to a good history and physical examination, certain tests are performed routinely prior to any major renal surgery. These include ECG, chest radiography, complete blood cell count, and electrolyte profile with BUN and creatinine levels.

Preoperative pulmonary function testing and blood gas analysis are necessary in patients in whom impaired respiratory function is suspected. A flank position with lateral flexion of the spine can decrease ventilatory capacity and venous return, resulting in hypotension and hypoxia. Thus, an anterior surgical approach with the patient in the supine position is used in patients with significantly impaired respiratory function. Preoperative breathing exercises, alleviation of bronchospasm, and cessation of smoking help prevent postoperative cardiorespiratory problems.

Patients should be asked about any use of alcohol or the ingestion of drugs or aspirin that may influence blood clotting. Prothrombin time, activated partial thromboplastin time, and a platelet count are used routinely to identify bleeding tendencies.

The anatomy of the urinary tract is usually examined prior to any nephrectomy. These studies include intravenous pyelography, cystoscopy, retrograde pyelography, ureteroscopy, cystourethrography, CT scanning, ultrasonography, MRI, renal angiography, and renal venography. These tests reveal the location of the kidneys; any anatomic variations such as a duplicated ureter, horseshoe kidneys, or multiple arteries or veins; and associated pathology such as renal stones, transitional cell carcinomas of the bladder or ureter, and possible lesions of the contralateral (ie, remaining) kidney.

CT scanning is the most cost-effective method of evaluating a suspected renal mass lesion and is currently the method of choice for detecting and staging renal carcinoma.

Differential renal function is often assessed noninvasively with computerized isotope renography (renal scan) using radioactive iodine (iodine 131) or technetium-99m.

Organism-specific antibiotic therapy is instituted at least 48 hours after surgery if the patient has evidence of an upper or lower urinary tract infection.

Preoperative percutaneous embolization of the kidney is occasionally rendered for patients with an arterialized vena cava thrombus or if medial extension of the tumor interferes with early ligation of the renal artery. Angioinfarction commonly leads to transient flank pain, which requires analgesic medication.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!