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Urology (Expert Forum)
Laparascopic Nephrectomy????
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Laparascopic Nephrectomy????
by reynold, May 01, 2005 12:00AM
I am a white male aged 32 - 6 ft - 220 lbs from the UK
My background is that in 2001 I was diagnosed by our National Health Service (state provided Health Care) to have a left kidney which contained a cyst ( near the center), and some calcified ‘lumps’ (largest about 10mm I think imbedded in the infected tissue and no apparent movement); all of this was contained in approximately the lower 1/3 of the organ. Upon final assessment by my specialist, I was told that the situation had probably existed since childhood and was caused by some early infection that had long since gone away. I was told there was no need to do anything further as the whole area was now in a state of dormancy, and not getting worse. I was told of the possibility of having the bottom 1/3 removed. X rays were taken with contrast and also CT scans with contrast were carried out. I was then examined under general anesthetic by probe into my kidney I think to carry out an efficiency test with contrast whilst anesthetized which turned out to show that the remaining good tissue was compensating for the infected tissue. Apparently at the time they were unable to see exactly what the infected area in the lower left pole looked like or take a sample. I was later tested for Tuberculosis, which was negative.
The periodic pain continued to grow in frequency (from say bi monthly to maybe every 3 weeks) and strength until in August 2004 I was told the best way forward was a new CT scan with contrast. The diagnosis after this was that the infection, still of unknown type had now consumed about 3/4 of the kidney and the opinion was that the whole kidney would now need removal. I had read what was available on the internet about the laparascopic surgery available in the US and it would appear to show a greater level of enthusiasm and experience in this field.
I have been told that I am not a likely candidate for a laparascopic nephrectomy in the UK. The reason for this is that it will probably be too ‘sticky’ since the kidney is infected. The body’s reaction to this I am told is to build up protection around the organ that will probably make it awkward for this type of removal. All the infection is internal to the kidney, from what I have seen from the CT scan imagery, my other kidney is completely normal.
I am trying to establish if my problem could be easily dealt with laparascpoically. And to whether or not it is simply a matter of an experience shortfall in the UK. I am being seen by a surgeon who does not practice the laparascopic method, but he has consulted others at another hospital who do and on our system it sometimes can seem to get a little clouded when offering two services, one much more expensive than the other. As I have seen on a number of hospital websites in the US that infected kidneys/with stones/cysts/ infection are ideal candidates for the laparascopic method I am confused with the advice I am currently getting. Any advice would be very useful and if anybody knows, the average cost of a laparascopic nephrectomy at a US hospital. Thanks, Reynold.
My background is that in 2001 I was diagnosed by our National Health Service (state provided Health Care) to have a left kidney which contained a cyst ( near the center), and some calcified ‘lumps’ (largest about 10mm I think imbedded in the infected tissue and no apparent movement); all of this was contained in approximately the lower 1/3 of the organ. Upon final assessment by my specialist, I was told that the situation had probably existed since childhood and was caused by some early infection that had long since gone away. I was told there was no need to do anything further as the whole area was now in a state of dormancy, and not getting worse. I was told of the possibility of having the bottom 1/3 removed. X rays were taken with contrast and also CT scans with contrast were carried out. I was then examined under general anesthetic by probe into my kidney I think to carry out an efficiency test with contrast whilst anesthetized which turned out to show that the remaining good tissue was compensating for the infected tissue. Apparently at the time they were unable to see exactly what the infected area in the lower left pole looked like or take a sample. I was later tested for Tuberculosis, which was negative.
The periodic pain continued to grow in frequency (from say bi monthly to maybe every 3 weeks) and strength until in August 2004 I was told the best way forward was a new CT scan with contrast. The diagnosis after this was that the infection, still of unknown type had now consumed about 3/4 of the kidney and the opinion was that the whole kidney would now need removal. I had read what was available on the internet about the laparascopic surgery available in the US and it would appear to show a greater level of enthusiasm and experience in this field.
I have been told that I am not a likely candidate for a laparascopic nephrectomy in the UK. The reason for this is that it will probably be too ‘sticky’ since the kidney is infected. The body’s reaction to this I am told is to build up protection around the organ that will probably make it awkward for this type of removal. All the infection is internal to the kidney, from what I have seen from the CT scan imagery, my other kidney is completely normal.
I am trying to establish if my problem could be easily dealt with laparascpoically. And to whether or not it is simply a matter of an experience shortfall in the UK. I am being seen by a surgeon who does not practice the laparascopic method, but he has consulted others at another hospital who do and on our system it sometimes can seem to get a little clouded when offering two services, one much more expensive than the other. As I have seen on a number of hospital websites in the US that infected kidneys/with stones/cysts/ infection are ideal candidates for the laparascopic method I am confused with the advice I am currently getting. Any advice would be very useful and if anybody knows, the average cost of a laparascopic nephrectomy at a US hospital. Thanks, Reynold.
Doctor's Answer
by Kevin Pho, MD, May 03, 2005 12:00AM
, May 03, 2005 12:00AM
I can say that laparoscopic nephrectomy is not uncommon here in the US. Whether you are a candidate for such a procedure will depend on the lesion in question and the skill of the surgeon.
The laparoscopic method is associated with a shorter post-op course, as well as possible more manageable post-op pain.
I do not know the cost of such as procedure, however I would consider a referral to any major academic medical center (i.e. a university-based hospital in any major US city).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The laparoscopic method is associated with a shorter post-op course, as well as possible more manageable post-op pain.
I do not know the cost of such as procedure, however I would consider a referral to any major academic medical center (i.e. a university-based hospital in any major US city).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
