Approximately 5000 new cases of kidney cancer annually in the UK. Increasingly, they are found on ultrasound scanning for unrelated symptoms. Often they are small, confined within the kidney and without any symptoms, but they can be large, causing abdominal symptoms, such as bleeding, pain, bloating or indigestion.
Investigation of urinary infections or bleeding is usually simple and quick using ultrasonography, X-rays or CT scanning. Often inspection of the bladder under local anaesthetic is required with a flexible telescope, to ensure no bladder problems. These tests are all rapidly available as an outpatient.
Conservative treatment –
Some patients with small tumours or who are elderly or with medical problems may be managed with observation only. This is only carried out if the risks of surgery are thought to be greater than the benefit of removal of a tumour. Serial scans are performed and surgery only offered if the tumour changes.
Laparoscopic nephrectomy –
Laparoscopic (key-hole) removal of the kidney to treat kidney cancer or other conditions is now standard practise in specialist units. The kidney is freed on the inside using specialist instruments through tiny incisions in the loin or abdomen, and the kidney is removed in a bag through a small incision low down in the abdomen, similar to a hernia repair or appendix removal. This is significantly less painful than open kidney surgery, with a faster recovery, shorter stay in hospital (on average only one night) and faster return to work/leisure activities etc. Peter Cooke has performed laparoscopic nephrectomy as a day case in selected patients.
Partial nephrectomy –
Some tumours may be small enough to allow their removal while preserving the rest of the kidney. This is can be performed by open, laparoscopic or robotic surgery. This has the advantage of preserving kidney function for the long term and is especially important in patients with only one kidney or pre-existing renal failure, who might otherwise need dialysis.
Treatment for PUJ Obstruction
Laparoscopic or robotic pyeloplasty
This procedure is used to treat PUJ obstruction, by removing the narrowed area responsible for causing kidney blockage and symptoms, and reconstructing the kidney’s drainage. It was one of the first procedures in urology to be developed as a laparoscopic operation. Technical skill and significant training is required to achieve the delicate suturing for this reconstructive procedure.
Peter Cooke no longer carries out kidney surgery due to his large prostate surgery caseload. He refers patients on to other surgeons as required.
Stone Disease Management
Many smaller stones will cause few symptoms and can be managed by altering fluid intake, and observation with regular check-ups and X-rays. Stones that are enlarging or causing pain, blockage or infections can be treated in a number of ways, depending on their size and position.
Telescopic removal of stones can be done through the bladder and up the ureter tube (ureteroscopy), or directly through the skin into the kidney (percutaneous removal). Stones can be removed whole, but more commonly require fragmentation by an instrument or laser. Selected smaller kidney stones are often best treated by ESWL (shockwave treatment), which is performed as an outpatient procedure without the need for anaesthesia or surgery.
Midlands Urology work in partnership with other surgeons to offer specialist complex stone management.