Prior to Kidney Surgery

UncleBob

Prior to undergoing a partial removal of a kidney in Stage 1, how does one decide which doctor, which hospital to use?

Is it very important to use the doctor highly recommended by one's own internist at his hospital?

Is possible partial removal of rib anything to worry about or should one go with a doctor who says he can do the procedure without removing the rib?

It's all very confusing when one is initially diagnosed and well meaning friends make it even more difficult by approving or disapproving of your choice of physician. How does one make the choice if they all seem good?

Chicago

Hey Bob,

You're describing the exact situation I was in two years ago when I had the same operation.

I actually started with a different urological surgeon, and switched on the advice of my internist. Not a difficult decision for me, since my internest is the dean of the medical school which is part of the hospital.

My first urologist was a great guy, and someone with whom I personally felt comfortable. He did not have a lot of experience though. The one who did my operation is an MD/PhD, trained at Sloan Kettering and Cleveland Clinic. On paper, an easy choice. It is not too difficult to look up their qualifications online. One thing I liked about him was that he was always willing to answer all of my questions honestly, and in language I could understand. Remember, once the operation is over, this is someone with whom you are going to be seeing again at least once or twice a year for years to come to follow up.

I also had my rib removed. Let me tell you, that made the healing process after the operation a lot more difficult and painful. I'm sure a lot of surgeons would have done the operation without removing it, but look at the alternatives.

The rib was removed to get better access to the affected area. The partial removal is a lot more complicated than removing the whole thing. If things start to bleed, they need to have easy access to the exposed area to stop it. Also, the worst thing that can happen with RCC is to have it spread outside the kidney. The better access they have to the area, the less likely it will be that the cancer cells can spread accidentally during the procedure.

And that's where the experience of the urological surgeon comes into play. My guy really opened me up -- practically spine to navel. But there was a payoff. The broad exposure enabled him to carve into my kidney very carefully, and remove only what was necessary. He left me with over 90 % of the kidney, when the less experienced docs said I would have to lose at least a third, and likely half of it. Saving practically all of the kidney was a lot more important to me than the rib.

The main question I would ask you is how much to you trust your internist? If you really feel comfortable with him, then his strong recommendation is probably the best thing you can get if your hospital is experienced in this particular area.

Feel free to contact me privately if you have any questions. I really have been there.

UncleBob

Chicago said:

Hey Bob,

You're describing the exact situation I was in two years ago when I had the same operation.

I actually started with a different urological surgeon, and switched on the advice of my internist. Not a difficult decision for me, since my internest is the dean of the medical school which is part of the hospital.

My first urologist was a great guy, and someone with whom I personally felt comfortable. He did not have a lot of experience though. The one who did my operation is an MD/PhD, trained at Sloan Kettering and Cleveland Clinic. On paper, an easy choice. It is not too difficult to look up their qualifications online. One thing I liked about him was that he was always willing to answer all of my questions honestly, and in language I could understand. Remember, once the operation is over, this is someone with whom you are going to be seeing again at least once or twice a year for years to come to follow up.

I also had my rib removed. Let me tell you, that made the healing process after the operation a lot more difficult and painful. I'm sure a lot of surgeons would have done the operation without removing it, but look at the alternatives.

The rib was removed to get better access to the affected area. The partial removal is a lot more complicated than removing the whole thing. If things start to bleed, they need to have easy access to the exposed area to stop it. Also, the worst thing that can happen with RCC is to have it spread outside the kidney. The better access they have to the area, the less likely it will be that the cancer cells can spread accidentally during the procedure.

And that's where the experience of the urological surgeon comes into play. My guy really opened me up -- practically spine to navel. But there was a payoff. The broad exposure enabled him to carve into my kidney very carefully, and remove only what was necessary. He left me with over 90 % of the kidney, when the less experienced docs said I would have to lose at least a third, and likely half of it. Saving practically all of the kidney was a lot more important to me than the rib.

The main question I would ask you is how much to you trust your internist? If you really feel comfortable with him, then his strong recommendation is probably the best thing you can get if your hospital is experienced in this particular area.

Feel free to contact me privately if you have any questions. I really have been there.

Hey Chicago.......You are amazing, Thank you so much.

I do trust my internist, have great communication with him and he has been my primary care provider for about 10 years. The Urologist that he referred me to is the Chief of Urology at their hospital, a man with much experience in his late 60s. He told me that it might be necessary to remove part of the 12th rib, but didn't explain to me why. You clarified it nicely for me.

The MD who I went to as a second opinion is with Sloan Kettering and said that his approach was NOT to remove the rib and that the scar would be about 8" on flank side of body. His philosophy is to save as much of the kidney as possible. The Urologist at my internist's hospital also wants to salvage as much of the kidney as possible too.

I guess that your doc in Chicago did not train with the man I saw at Sloan.

This does get quite confusing, doesn't it and worrysome but because you showed me why the rib is removed (for better access, to control bleeding etc,) it makes sense to go that route if it will save more of the kidney.

Now if I wanted to reply to you personally and not on line for all to see (perhaps my own doctor,) how would I go and do that?

One more question if I may ask.........How much time where you laid up after the surgery, both in hospital and at home?

What is your age range?

How much pain was there and was in controlled with medication? This is my first surgery and I am scared to death........I even still have my tonsils!

Again many thanks