What partial nephrectomy is, and why keeping the kidney matters
In partial nephrectomy, also called kidney-sparing or nephron-sparing surgery, only the tumour and a narrow margin of normal tissue are removed. The kidney is then stitched back together.
Keeping kidney tissue matters because diabetes, high blood pressure and age can all reduce kidney function over the years, and a person who has lost one whole kidney has less in reserve. For suitable small tumours, guidelines consider cancer control after partial nephrectomy similar to removing the whole kidney.
Not every small kidney mass is cancer. Some turn out to be benign growths such as an angiomyolipoma or an oncocytoma. Kidney-sparing surgery means a benign lump does not cost you a kidney.
Who is suitable for partial nephrectomy
- Tumours often under about 4 cm, especially on the outer surface of the kidney.
- Tumours of about 4-7 cm, and sometimes larger, when their position allows safe removal.
- Any tumour where keeping kidney tissue is essential: a single kidney, tumours in both kidneys, or existing kidney disease.
It is usually not suitable for large tumours deep in the centre of the kidney or growing into the kidney vein; these need radical nephrectomy.
| Option | Suits | Points to weigh |
|---|---|---|
| Partial nephrectomy | Small tumours in fit patients | Keeps the kidney; slightly higher risk of bleeding and urine leak |
| Radical nephrectomy | Large or central tumours | Simpler operation; loses the whole kidney |
| Active surveillance | Small tumours in older or frail people | Regular scans; surgery if it grows |
| Ablation (heat or cold through a needle) | Small tumours when surgery is risky | Done by interventional radiologists; more chance of needing repeat treatment |
Tests before partial nephrectomy
- CT scan with contrast in several phases, or MRI, to show the tumour’s size, depth and closeness to the urine-collecting system and main blood vessels. Some patients need a CT angiogram to map the arteries.
- Kidney function tests and sometimes a renal scan to measure each kidney’s share of the work. Our article on kidney cancer symptoms, stages and treatment explains how the scans are read.
- Biopsy in selected cases, for example when the scan picture is unclear or watching is being considered.
- Fitness tests for anaesthesia, and arrangements for blood if needed. Blood thinners are stopped as advised.
From the scans, the surgeon judges how complex the removal will be and whether laparoscopic or open surgery is safer for you.
How partial nephrectomy is done, step by step
- General anaesthesia is given and you lie on your side. For laparoscopy, three or four small ports are placed; open surgery uses a cut below the ribs.
- The kidney is exposed and the fat is cleared from the tumour so its edges can be seen.
- The kidney artery is usually clamped for a short time, so the tumour can be cut out without heavy bleeding. The time the kidney spends without blood flow at body temperature is called warm ischaemia. The kidney tolerates this for a limited time, so the aim is to keep it short, usually well under half an hour. Some small outer tumours can be removed without clamping.
- The tumour is cut out with a thin rim of normal tissue.
- Any opening into the urine-collecting system is closed, and the kidney is stitched to stop bleeding. The clamp is then released.
- The tumour is removed in a bag and a drain is placed.
It usually takes two to four hours. In open surgery the kidney can be cooled with ice to allow a longer clamp time for complex tumours. If the tumour cannot be removed safely on its own, the whole kidney may have to be removed; this is discussed and consented beforehand.
The operation is at ManglamPlus Medicity with a laparoscopic camera and instruments, small vascular clamps, fine stitches, materials that help blood clot and a retrieval bag. Read more about laparoscopic urology surgery.
Hospital stay and recovery after partial nephrectomy
| Time | What to expect |
|---|---|
| Day of surgery | Bed rest, drain, catheter and pain relief |
| Days 1-3 | Walking and eating; catheter out; drain removed once it is dry |
| Days 3-5 | Home, if the drain is out and you are comfortable |
| Weeks 1-4 | Gradual return to normal; desk work from about 2-4 weeks |
| Up to week 6 | No heavy lifting, straining or vigorous exercise while the stitched kidney heals |
Late bleeding from the repaired kidney can occur up to a few weeks later. Go to the hospital at once if you see heavy blood or clots in the urine, have sudden pain in the side, feel faint, or develop fever. Call the clinic for wound discharge or leg swelling.
Risks of partial nephrectomy: bleeding and urine leak
- Bleeding, during surgery or days to weeks later. Late bleeding is often from a small damaged artery, which an interventional radiologist can usually seal through a thin tube passed from the groin (angioembolisation).
- Urine leak from the repaired collecting system. It usually stops on its own with the drain left longer; sometimes a DJ stent (a thin internal tube from kidney to bladder) is placed.
- Positive margin, meaning cancer cells reach the edge of the removed tissue. This is usually managed with closer scans, and sometimes further treatment.
- A short-term dip in kidney function, which usually recovers.
- Change to open surgery or to radical nephrectomy, infection, blood clots and hernia.
Most of these settle without lasting harm to the kidney. Careful planning from the scans, a short clamp time, watertight stitching and a drain all help lower the risks. If a DJ stent is placed, it is removed later in a short cystoscopy.
Follow-up scans after partial nephrectomy
About one to two weeks after surgery, the pathology report tells you whether the tumour was cancer, its type and grade, and whether the margins are clear. Follow-up CT or ultrasound scans are then planned according to that risk, usually every six to twelve months at first and then less often, for several years. Blood pressure and kidney function are checked too.
The scans look at the repaired kidney, the other kidney and the chest. If something new appears, it is usually small and found early. See also the kidney cancer page and the overview of urology cancer surgery.
Cost of partial nephrectomy in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Laparoscopic or open surgery, and how complex the tumour’s position makes the operation
- Scans before surgery, such as multi-phase CT, CT angiogram or renal scan, and any biopsy
- The room category at ManglamPlus Medicity and the number of nights, which depends on when the drain comes out
- Extra procedures if needed, such as a DJ stent for a urine leak or angioembolisation for bleeding
- The pathology report and follow-up scans
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Partial nephrectomy with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
What size of kidney tumour can be removed by partial nephrectomy?
Tumours under about 4 cm are the usual candidates. Larger tumours, up to about 7 cm and sometimes more, can be removed this way when their position allows it safely.
Is partial nephrectomy as effective as removing the whole kidney?
For suitable small tumours, guidelines consider cancer control to be similar, while more kidney function is kept. Your scans decide whether you are suitable.
Does clamping the kidney damage it?
A short clamp time is well tolerated by a healthy kidney. The aim is to keep warm ischaemia short, and some tumours can be removed without clamping at all.
Is every small kidney lump cancer?
No. Some are benign growths. Scans cannot always tell the difference, which is one reason kidney-sparing surgery is preferred for small masses.
What if the tumour cannot be removed with part of the kidney?
If it is not safe during the operation, the whole kidney may be removed. This is uncommon and is discussed with you before surgery.
When can I lift heavy things again?
Usually after about six weeks. The stitched kidney needs time to heal, and straining too early can cause late bleeding.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.