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Nephroureterectomy
A nephroureterectomy is surgery to remove an entire kidney, its ureter, and usually a small cuff of the bladder — most often to treat cancer in the lining of the kidney's drainage system or ureter.
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Briefly about this treatment
Indications
High-grade or invasive cancer in the lining of the kidney's collecting system or ureter (upper tract urothelial carcinoma), or, less commonly, a severely damaged, non-functioning kidney causing recurrent infection, obstruction or pain.
Risks
Bleeding, infection, and reduced kidney function are the main risks. They're minimised by careful patient selection, experienced surgical teams, and choosing the least invasive approach that's still safe for the cancer.
Pre-procedure
Blood tests, a CT urogram and other imaging, an anaesthesia consultation, and fasting per protocol; blood thinners such as warfarin, aspirin or clopidogrel are usually paused in advance.
Follow-up
Scheduled clinic visits in the weeks after surgery, then regular surveillance — cystoscopy, urine cytology and imaging — to watch for recurrence and monitor how the remaining kidney is functioning.
What is Nephroureterectomy? An expert explains
Your urinary tract — the inside of your kidney’s drainage system, the ureter, and the bladder — is lined by the same type of tissue, called urothelium. Cancer that starts in this lining inside the kidney or ureter behaves differently from ordinary kidney cancer, and because the whole lining is at risk, surgeons typically remove the kidney, the full length of the ureter, and a cuff of bladder tissue together — not just the tumor — to reduce the chance the cancer seeds elsewhere along that lining. Surgeons in the United States perform roughly 1,000 to 2,000 nephroureterectomies each year, most often for this reason.
There are three main surgical approaches:
- Open nephroureterectomy — one or two larger incisions in the flank/abdomen; used for larger or more invasive tumors.
- Laparoscopic (keyhole) nephroureterectomy — several small incisions and a camera; less tissue trauma, typically faster recovery.
- Robotic-assisted nephroureterectomy — laparoscopic technique with robotic instruments for extra precision, including newer single-port approaches.
Your urologist chooses the approach based on tumor size, location, grade, and your overall fitness for surgery.
The main indication is high-grade or invasive upper tract urothelial carcinoma. Less commonly, it’s used for a kidney that’s stopped working properly and is causing recurrent infection, obstruction, or pain, where removing the kidney and ureter together avoids leaving diseased tissue behind. Kidney-sparing options (endoscopic tumor removal, partial ureterectomy) are considered first when the tumor is low-grade and the other kidney’s function needs protecting.
Signs it may be time for Nephroureterectomy
These are things you might notice yourself, not a checklist for diagnosing cancer — your doctor investigates first, and surgery is only one possible outcome.
- Blood in your urine — visible, or picked up on a routine urine test. Painless blood in the urine is the single most common early sign and is worth checking even if it happens only once.
- Persistent one-sided flank or lower back pain that doesn’t ease off.
- A mass or fullness you or your doctor can feel in the abdomen or flank.
- Urinary tract infections that keep coming back, especially if they seem tied to one kidney.
- Unexplained weight loss or fatigue alongside any of the urinary symptoms above.
These are the conditions linked to this treatment in the directory. Your clinician decides whether treatment is appropriate using your symptoms, examination and test results.
- Renal Cell Carcinoma (RCC) — the most common kidney cancer in adults, and a key differential when a kidney tumor is found.
- Bladder Cancer (Upper Tract Obstruction) — urothelial cancer that can involve the same lining removed in a nephroureterectomy.
- Nephrolithiasis (Kidney Stones) — hard mineral deposits that can cause similar pain and blood in the urine, and sometimes a non-functioning kidney.
- Hydronephrosis — swelling of the kidney from blocked urine flow, which can result from a tumor or long-standing obstruction.
- Ureteropelvic Junction Obstruction — a blockage between the kidney and ureter that can damage kidney function if left untreated.
Remember: These entries are not a diagnosis or a treatment recommendation. Discuss your symptoms and test results with a qualified clinician.
When to consult a specialist
If you’ve noticed blood in your urine, even once, or a dull ache on one side that isn’t going away, try not to jump to the worst conclusion — most causes turn out to be straightforward, and the next steps are usually simple: a blood test, a urine test, and sometimes an ultrasound or CT scan. These give your doctor a clear picture fast, and the sooner you start, the sooner you’ll know what you’re dealing with. You don’t need to work this out alone — find a specialist to get checked and talk through what your results mean for you.
How a session works
- Before surgery: Blood tests, imaging review, and an anaesthetic assessment. You’ll be told which medicines to pause (blood thinners like warfarin, aspirin or clopidogrel need advance planning) and given fasting instructions.
- Anaesthesia: A full general anaesthetic is used for all approaches; some centers add an epidural to help with pain control afterward, especially for open surgery.
- The operation itself:
- Open: An incision in the flank (sometimes extended toward the abdomen) to remove the kidney and surrounding fat, plus a separate lower incision to remove the rest of the ureter and bladder cuff.
- Laparoscopic/robotic: Several small ports are used to free and remove the kidney and ureter; the bladder cuff is often detached endoscopically through the bladder, and the specimen is removed through one slightly larger incision.
- A catheter is left in your bladder to drain urine while the bladder repair heals, and a drain may be left at the surgical site.
- Duration: Typically a few hours, depending on approach and complexity.
- Afterward: The removed kidney, ureter and bladder cuff are sent to pathology to confirm the cancer’s grade and stage, which guides whether any further treatment (such as chemotherapy) is needed.
Session duration
2–4 hours
recorded for this treatment
Cost verify
$12000–$23000
indicative range
Anesthesia
General
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
For the right candidate, removing the whole kidney, ureter and bladder cuff together treats the cancer at its source and removes the tissue most at risk of it coming back in the same area.
- Removes the entire at-risk urothelial lining on the affected side, lowering the chance the cancer recurs in leftover tissue
- Can be curative for localized disease
- Minimally invasive (laparoscopic/robotic) approaches offer less pain, shorter hospital stays and a faster return to normal activity than open surgery
- One healthy kidney is generally enough to maintain normal kidney function for most people
Risks & side effects
The treatment has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data: bleeding, infection, and vascular or wound-related issues are the main concerns, and they’re minimised by careful patient selection and experienced surgical teams.
- Bleeding, occasionally requiring a blood transfusion or further surgery
- Infection at the wound site, or a chest infection linked to reduced deep breathing and activity after surgery
- Blood clots — deep vein thrombosis (DVT), which can rarely travel to the lungs (pulmonary embolism)
- Reactions to general anaesthesia
- Pain or discomfort at the incision site, which is almost universal after surgery
- Bulging of the abdominal wall below the wound from nerve damage to the supporting muscles, affecting roughly 1 in 2 to 1 in 10 patients
- Reduced kidney function, more significant if the remaining kidney was already impaired
Who it may not suit: These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
What happens during & after
Immediately after surgery you’ll recover in a monitored area, then move to a ward. Expect a catheter for several days, pain managed with medication, and encouragement to get up and walk early to reduce clot risk. Hospital stay after open surgery is typically around five to seven days, while laparoscopic surgery usually means a shorter stay of about two to three days. There’s roughly a 1 in 10 chance a planned laparoscopic procedure needs to be converted to open surgery if the kidney and ureter can’t safely be removed through the small incisions.
Possible complications
Most people recover without a major complication, but a few things are worth knowing about in advance.
- Tumor recurrence elsewhere in the urinary tract — between roughly 1 in 2 and 1 in 10 patients need repeated telescopic (cystoscopic) bladder examinations to watch for recurrence, since the bladder lining shares the same tissue type and remains at risk
- Hernia at the incision site requiring further treatment
- Need for additional cancer treatment, such as chemotherapy, if pathology shows higher-risk disease
- Longer-term reduction in kidney function, particularly relevant if you later develop diabetes, high blood pressure, or need to protect your remaining kidney
- Rarely, injury to nearby organs during surgery
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
- In hospital: 2–3 days after laparoscopic/robotic surgery; 5–7 days after open surgery, plus catheter care and pain management.
- At home: Early weeks focus on wound care, gradually increasing walking, and avoiding heavy lifting or driving until cleared by your surgeon (typically several weeks). Most people are fully recovered around six weeks after surgery, though recovery after open surgery can take up to three months and sometimes longer.
- Follow-up: Regular surveillance — cystoscopy (bladder checks), urine cytology, and imaging of the remaining kidney and urinary tract — because of the ongoing risk of bladder recurrence and, rarely, disease in the other kidney. Your oncology team will set a schedule based on your cancer’s stage and grade.
- Watch for and report: Fever, worsening wound redness or discharge, heavy bleeding, calf swelling or pain, chest pain or breathlessness, or inability to pass urine.
- Kidney health going forward: You’ll be monitored with periodic bloodwork (creatinine, eGFR) to track how well your remaining kidney is coping.
Clinics offering Nephroureterectomy
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
University Hospital
Urologic Oncology & Robotic Surgery
ISO 9001European Urology Boardda Vinci Robotic Center
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Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Academic Medical Center
Kidney Transplantation
Joint CommissionUNOS CertifiedLiving Donor Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Good questions
Most Common Questions
Will I need dialysis after a nephroureterectomy?
Most people have normal or near-normal kidney function afterward because the remaining kidney compensates. Dialysis is only a concern if your remaining kidney already has reduced function — your team will check this before surgery.
Is nephroureterectomy the same as a nephrectomy?
No. A nephrectomy removes only the kidney. A nephroureterectomy removes the kidney and the entire ureter, usually with a cuff of bladder, because urothelial cancer can involve the whole length of that lining.
Can I keep the kidney and just remove the tumor?
Sometimes. For small, low-grade tumors — especially if you have only one working kidney or reduced kidney function — your urologist may offer endoscopic (ureteroscopic) tumor removal or a segmental ureter resection instead. This trades a lower risk of kidney failure against a higher risk of the tumor coming back.
How is UTUC diagnosed before surgery is even discussed?
Typically a CT urogram (a CT scan with contrast that outlines the urinary tract), urine cytology, and ureteroscopy with biopsy to directly view and sample the tumor.
Should I see a urologist or a nephrologist for this?
A urologist (specifically a urologic oncologist, if available) performs and manages a nephroureterectomy. A nephrologist may be involved afterward to help monitor kidney function if your remaining kidney needs closer follow-up.
What should I ask a surgeon before choosing them for this procedure?
How many nephroureterectomies they perform annually, which surgical approach they recommend for your specific tumor and why, and how surveillance will be handled after surgery.
Sources
- NephroureterectomyCleveland Clinic
- Radical removal of the kidney and ureterCambridge University Hospitals NHS Trust
- Overview, Diagnosis, and Perioperative Systemic Therapy of UTUCCancers (2023, via PMC)
- Diagnosis and Management of Upper Tract Urothelial Carcinoma: A ReviewCancers (2025, via PMC)
- Understanding the Economic Burden of Treating Low-Grade Upper Tract Urothelial Cancer in the United StatesPennsylvania State University (Thacker et al.)