A partial nephrectomy is a surgical procedure that involves removing part of a kidney. A partial nephrectomy is usually performed whenever a person has certain lesions/tumors on a kidney. Two types of lesions or tumors can be found on the tumor–malignant, which means the lesion is cancerous or benign, a non-cancerous tumor.
Kidney tumors develop and take either an endophytic or exophytic form. An endophytic tumor grows inwardly in the kidney and is usually benign and not life-threatening. A tumor that is exophytic protrudes outward from the surface and is usually malignant/cancer.
A 63-year-old male acquaintance, “Robert,” underwent a partial nephrectomy for an exophytic tumor that was 11 millimeters long, the size of a large pea. The lesion was located on the outer edge of Robert’s right kidney. Robert’s doctor believed the lesion to be stage 1 kidney cancer, meaning it had not yet spread to the lymph nodes. The operation lasted 2 hours, including surgery prep and the surgical procedure.
The following interview was conducted on the 7th day following Robert’s partial nephrectomy.
Interviewer: How well did your surgeon prepare you for surgery?
Robert: The surgeon and his staff did an excellent job preparing me for what would be involved in the surgery and hospitalization. They did not prepare me for what to expect during post-hospitalization and recovery periods.
Interviewer: What have you experienced after surgery that you weren’t expecting?
Robert: The 2 major surprises were the extent of abdominal bloating in the first 3 or 4 days following surgery and the intense shoulder pain resulting from the CO2 gas used during surgery to inflate my abdomen.
I wish the surgeon and his staff would have told me about the shoulder pain that could accompany the surgery and assured me the pain would go away in a few days. They might also have offered tips on managing the shoulder pain.
Interviewer: Is there anything that has frightened you during your recovery?
Robert: The greatest fear I experienced the first few days after surgery was that I might inadvertently open my incision as a result of coughing or sneezing.
Interviewer: How has pain you’ve experienced progressed over the 7 days since you underwent the nephrectomy? How do you rate pain now on a scale of 1=no pain to 10=most painful?
Robert: I experience far less pain from the incisions than I expected. I required little morphine while hospitalized and discontinued pain medication by the 4th day after surgery. One week after surgery, I rate my pain a “0.”
Interviewer: What is the most difficult part of your recovery from the partial nephrectomy?
Robert: Being careful not to strain or lift everyday objects.
Interviewer: On a scale of 1=no pain to 10=most painful, what is the highest your pain level has been since surgery?
Robert: The pain in my shoulder reached a 7-8 on the third and fourth days after surgery. Incision pain was quite intense when I coughed, a 7 or 8, during the first 4 days after surgery.
Interviewer: Have you engaged in behaviors since surgery that the doctor said you shouldn’t do?
Interviewer: How many incisions do you have? How large are they?
Robert: I have three incisions. The first is 1-1/8 inches long, the second is also 1-1/8 inches long and the third is 4-1/2 inches, located on my upper right abdomen horizontally, across my side.
Interviewer: What surprises you the most about your recovery?
Robert: There are two surprises. The first was how much of the first 3 or 4 days my body required sleep and the second was how fast the pain dissipated following surgery.
Interviewer: What advice can you give others who are about to have a partial nephrectomy?
Robert: I have three suggestions: Expect some pain in the shoulder and neck area which can be relieved by massage and heat (such as the use of thermal patches) in addition to pain medication. Take stool softeners per your doctor’s advice after surgery as they were very helpful in getting bowel function back to normal without placing undue strain on my incisions. Progressively increasing duration of walks from day 2 after surgery seemed to speed my overall recovery.
Interviewer: Is there anything your doctor recommended for you to do that you didn’t do and, in retrospect you wish you would have?
Robert: I used the incentive spirometer less often than recommended (hospital nurses suggested 10 breaths hourly) but now realize how important the tool was in clearing fluid from my lungs.
Communications with Surgeon and Staff at Southwest Florida Urologic Associates
Interview with Robert (alias)