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Flank Bulge

Posts: 46
Joined: Mar 2017

I've become very anxious about my open partial in 3 days after reading about this underreported condition called flank bulge. I'm even thinking of cancelling and talking to a few robotics surgeons first despite having all my pre-op testing and support team ready to go for surgery on Thursday. Don't mind the scar but a football sized bulge? That gives me pause. According to the study below, its a problem that needs addressing? Any comments? 



Permanent flank bulge is a consequence of flank incision for radical nephrectomy in one half of patients

Article in Urologic Oncology 22(1):36-9 · February 2004 with 169 Reads
DOI: 10.1016/S1078-1439(03)00099-1 · Source: PubMed
The objective of the study was to determine the incidence and predictors of post operative pain and flank bulging in patients undergoing nephrectomy for a renal tumor through a flank or thoracoabdominal incision. Only one previous retrospective study (1974) has directly addressed this issue in urologic patients. This reported a 3% incidence of flank bulging. This was at variance with our own experience. To determine the incidence of pain and post-operative flank bulge after flank or thoraco-abdominal incision, a cross sectional survey among in 70 patients, who had a nephrectomy for a renal tumor between 1996 and 2000, was assessed by telephone interview. Four surgeons contributed patients to the study. Thirty-four of seventy (49%) patients complained of a flank bulge persisting more than 1 yr after surgery. Durable flank pain was experienced by 24%. This was severe in 3% of patients. Median pain magnitude was 5/10. There was no difference in bulge incidence between surgeons (P = 0.49). Flank bulging occurred more frequently in left sided nephrectomy (P = 0.054) than right. Other parameters including gender, age, and tumor size had no correlation with the rate of either complication. In all patients who described a flank bulge, the deformity was durable; there were no cases of spontaneous resolution. Patients described a significant impact on QOL, particularly in those under 60 yrs. The overall rate of postoperative flank bulging is considerably higher than has been previously reported. This deformity affects quality of life. The observation that almost 50% of patients experience a flank bulge following a flank incision supports the shift towards laparoscopic nephrectomy, and should be incorporated into decision making regarding the optimal surgical approach. This may be particularly relevant in the choice between open partial nephrectomy and laparoscopic radical nephrectomy in a patient with a normal contralateral kidney.

Research paper: Permanent flank bulge is a consequence of flank incision for radical nephrectomy in one half of patients. Available from: https://www.researchgate.net/publication/8078962_Permanent_flank_bulge_is_a_consequence_of_flank_incision_for_radical_nephrectomy_in_one_half_of_patients [accessed Apr 3, 2017].

Dave418's picture
Posts: 95
Joined: Aug 2014

Those results are from 1996 to 2000 : "who had a nephrectomy for a renal tumor between 1996 and 2000". Big progress have been made since the in surgery. Stop worrying, if you Google all the procedures for nephrectomy, you will never have surgery. You'll always find a reason to cancel and you'll never get the "thing" out... 

Posts: 46
Joined: Mar 2017

The common denominator is the incision. Partial or radical nephrectomy's don't make a difference not sure there have been any advances regarding incisions in the last 20 years.

stub1969's picture
Posts: 868
Joined: Jul 2016

Tesla: There are risks in any surgery.  The bigger questions I have is 1.)  if your urologist is a specialist with RCC, 2.) what is the number of surgeries your urologist performs in a month/year, 3.) have you talked to him/her about your concerns with a bulge?  If, the answer to these questions lead you to still question the expertise of your surgeon then you need to look for a new doctor and not worry about a bulge.  Good luck


foxhd's picture
Posts: 3183
Joined: Oct 2011

in health care. What do you do? Please put some info in your bio so people can reference. Dozens of members come and go. We could use the assist in tailoring responses.

Posts: 46
Joined: Mar 2017

I'm an MRI Technologist. I've updated my profile. Thanks for your interest.

Posts: 19
Joined: Jan 2017

Flank bulge is a known surgical complication for large abdominal incisions. It is fair to consider robotic surgery if that is a huge concern for you. But as with anything in medicine you need to weigh the risks and benefits - delaying the surgery theoretically could, albeit low, lead to higher risk of additional growth/spreading. It really depends on how much you hate that bulge, how large the primary tumor is, and how fast you can get an alternative robotic surgery. As a side note, the bulge itself can be fixed, at least partially, with a small plastic surgery later on. 

Posts: 1
Joined: Apr 2017

My RCC open nephrectomy (with the removal of my right kidney and a rib) was November 2006. My "bump" more of a bulge has been with me ever since. As a middle age woman facing other medical issues; I thought concerning myself with my personal appearance was vain (after all I am alive). I have had to change the way I dress, and I'm pretty self-conceious in a bathing suit. But the worst part of the bulge is the adhesions and some of my intestines get "stuck" and cause sharp pains relieved only by standing up and "adjusting" my insides. I explored  surgery to fix the bump. Surgery brings with a whole new set of problems, recovery, new adhesions and risk to my heart from being put out for the surgery.  My doctor said it wasn't worth the risk.  I think agree. Im sure, had I been given all the potential post-surgical issues, I would still have had the surgery...after all, the alternative is not acceptable. I have finally made friends with my bump, named it and accepted that it is a part of me. I  thought I would share this with all of you out there in various stages of recovery and hope it helps you with the battle of the bulge.

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