Nephroureterectomy
Surgery that removes the kidney, the whole ureter, and a small cuff of the bladder where the ureter enters, to treat cancer of the lining of the kidney's drainage system or the ureter.
Also called radical nephroureterectomy, RNU, NU, robotic nephroureterectomy, laparoscopic nephroureterectomy, nephroureterectomy with bladder cuff, bladder cuff excision, remove kidney and ureter
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (you are fully asleep)
- Time in the room
- About 3 to 5 hours
- Hospital stay
- Usually 1 to 3 nights
- Going home with
- Bladder catheter, often for about 5 to 10 days while the bladder heals
- Back to normal
- About 4 to 6 weeks
- Back to work
- Desk work in 2 to 4 weeks; physical work in about 6 weeks
Overview
The kidney collects urine in a funnel called the renal pelvis, which drains down a thin tube called the ureter to the bladder. All of these are lined by the same thin layer, the urothelium. Cancer that starts in this lining inside the kidney or ureter is called upper tract urothelial cancer, or UTUC. It is the same kind of cancer as most bladder cancers, but it is much less common: only about 5 to 10 in 100 urothelial cancers start in the kidney or ureter.
A nephroureterectomy removes the kidney, the entire ureter, and a small cuff of bladder wall around the spot where the ureter enters the bladder. The whole ureter and the cuff are removed because this cancer can grow along the lining, and a leftover stump of ureter has a high chance of growing a new tumor. It is the standard operation for high-grade or invasive tumors, and for low-grade tumors that are too large or too many to treat with a scope.
Most of these operations are now done through small keyhole cuts with a surgical robot or laparoscopic instruments. The bladder end can be handled through the same keyhole cuts, through a small lower cut, or with a scope through the urethra. Lymph nodes near the kidney and ureter are often removed for higher-risk tumors.
Because this cancer can also appear in the bladder later, in roughly 1 in 4 to 1 in 2 people, you will need regular bladder checks with a scope afterward. A single dose of chemotherapy placed in the bladder around the time of surgery lowers that risk.
The parts of your body involved
Each kidney makes urine, which collects in small cups called calyces and drains into a funnel called the renal pelvis. From there, urine flows down the ureter, a tube about 10 to 12 inches long, into the bladder. Everything from the calyces to the bladder is lined by urothelium, the same lining that coats the inside of the bladder. Because the whole lining shares the same exposures, such as tobacco smoke chemicals carried in urine, a tumor in one place raises the chance of another tumor elsewhere in the lining.
- Renal pelvis and calyces
The collecting funnel and cups inside the kidney. Upper tract tumors often start here.
- Ureter
The tube from the kidney to the bladder. Tumors can also start here, and the whole ureter is removed.
- Bladder cuff
A small ring of bladder wall around the ureter's opening. It is removed so no lining from the ureter is left behind.
- Kidney
Removed together with its fat, because the tumor is inside its drainage system.
- Lymph nodes
Small glands near the kidney and ureter that are removed for higher-risk tumors to check for spread.
Why it’s done
Your urologist recommends this operation when the tumor is aggressive, has grown into the wall, or cannot be controlled with kidney-sparing treatments. The goal is to remove all of the cancer along with every part of the lining where it is likely to come back.
- High-grade tumor
High-grade tumors grow and spread faster. Removing the kidney and ureter gives the best chance of cure.
- Tumor growing into the wall
When scans or biopsies suggest the tumor has grown into the muscle of the ureter or into the kidney, surgery is the main treatment.
- Large or many low-grade tumors
Low-grade tumors can often be treated with a laser or medicine, but not when they are too big or too many to control.
- Kidney-sparing treatment has stopped working
If tumors keep coming back despite scope treatments or medicine gel, removing the kidney and ureter may be safest.
- Bleeding or blockage
Some tumors cause ongoing blood in the urine or block the kidney.
Other options
- Kidney-sparing treatment with a scope
For small, low-grade tumors, a thin scope passed up the ureter can burn or laser the tumor away, followed by frequent checks. This keeps the kidney but needs lifelong close follow-up.
- Upper tract chemoablation (mitomycin gel)
A chemotherapy gel placed into the kidney once a week for 6 weeks can clear many low-grade tumors. It is not used for high-grade cancer.
- Removing only part of the ureter
For some tumors in the lower ureter, the surgeon removes just that segment and reconnects the remaining ureter to the bladder, keeping the kidney.
- Chemotherapy before surgery
For higher-risk tumors, some people receive chemotherapy before surgery, while both kidneys are still working, because removing a kidney can make some chemotherapy drugs unsafe afterward.
- Chemotherapy or radiation without surgery
For people who cannot have surgery, medicines and sometimes radiation are used, though they are less likely to cure the cancer.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and positioning
You fall fully asleep and a breathing tube is placed. You are turned onto your side, tumor side up, with the table bent slightly at the waist. A catheter is placed in your bladder.
More detail
Some surgeons begin with a short look in the bladder with a scope, and some free the bottom of the ureter from inside the bladder at the start. Others change your position partway through to reach the bladder end. Practice varies by surgeon and by where the tumor is.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake with an IV, a bladder catheter, squeezing sleeves on your legs, and sometimes a drain.
- Pain control
Scheduled acetaminophen and other non-opioid medicines, with opioids only if needed. Ibuprofen-type medicines are usually avoided with one kidney.
- Bladder spasms
The bladder repair can cause sudden cramping and an urge to urinate around the catheter. Medicine can calm the spasms.
- Walking and eating
You walk the same evening or next morning and start eating as your bowels wake up.
- Blood tests
Creatinine rises after a kidney is removed. Your team checks where it settles.
- Going home
Most people go home in 1 to 3 days, often still with the bladder catheter.
At home
- Catheter care
Keep the bag below your bladder, empty it when half full, and clean where the catheter enters your body daily with mild soap and water. Use a leg bag by day and a larger bag at night.
- Catheter removal
The catheter usually comes out after about 5 to 10 days. Some teams first do a bladder X-ray to check that the repair has sealed.
- Pain
Use acetaminophen on a schedule and the stronger pill only if needed. Avoid ibuprofen, naproxen and similar pills unless your doctor approves.
- Blood in the urine
Pink urine or small clots are common while the catheter is in, especially after walking. Drink fluids to keep it light.
- Incisions
Shower after 24 to 48 hours and pat dry. Avoid baths and swimming for about 2 to 4 weeks.
- Bowels
Avoid straining. Use a stool softener while taking opioid pain medicine.
- Activity and lifting
Walk several times a day. Avoid lifting more than about 10 to 15 pounds (5 to 7 kilograms) and hard exercise for about 6 weeks.
- Driving
Not while taking opioid pain medicine or with the catheter in. Most people drive again after about 2 weeks.
- Sex and work
Sex when comfortable and after the catheter is out. Desk work in 2 to 4 weeks, physical work in about 6 weeks.
Recovery timeline
- Day of surgerySurgery
You wake in recovery with a catheter and start walking that evening or the next day.
- Days 1 to 3Home
Most people go home in 1 to 3 days with the bladder catheter.
- About 1 weekCatheter out and pathology
The catheter usually comes out after 5 to 10 days. The pathology report shows the grade and stage and whether lymph nodes had cancer.
- Weeks 2 to 4Recovering
Pain fades, and many people return to desk work and driving.
- About 6 weeksBack to most activities
Lifting limits are usually lifted. If more treatment is recommended, it usually starts within about 3 months of surgery.
- 3 monthsFirst bladder check
A cystoscopy, a look into the bladder with a thin scope, is usually done about 3 months after surgery.
- Years 1 to 2Frequent checks
Bladder checks every few months and regular CT scans, because new bladder tumors are most likely in the first 2 years.
- Years 3 to 5 and beyondSpaced-out checks
If all is clear, checks become less frequent but continue for years.
What it feels like
People often feel blindsided by this diagnosis, especially after being told it is a kind of bladder cancer in the kidney. The recovery is like other kidney surgery, with the added nuisance of going home with a catheter.
Learning you need the kidney and ureter removed
Many people feel shock, and worry about losing a kidney and about their other kidney.
What helpsAsk your team for your kidney function numbers before and expected after surgery, and whether chemotherapy before surgery makes sense for you.
The first days
Shoulder-tip pain from the gas, soreness, and bladder spasms that feel like a sudden strong urge to urinate or a cramp low in the belly.
What helpsWalking eases the gas pain. Ask for medicine for spasms, and make sure the catheter tube is not kinked.
Going home with a catheter
Many people feel embarrassed and awkward with the bag, and worry about it leaking or being seen.
What helpsA leg bag under loose pants is hard to notice. Practice emptying it before you leave the hospital. It is usually only for about a week.
The catheter comes out
Relief, often followed by some burning, frequent urination, and a little leakage for a day or two.
What helpsDrink steadily, urinate when you feel the urge, and expect things to settle within a few days.
Waiting for results and planning follow-up
Worry about the stage and about future bladder tumors is common.
What helpsWrite down the grade and stage, and ask for your bladder-check schedule in writing. Knowing the plan helps.
Each follow-up cystoscopy
The quick scope test is mildly uncomfortable, and waiting for the answer can bring anxiety.
What helpsThe doctor can usually tell you the result before you leave the room. If a small bladder tumor is found, it is usually caught early and easy to treat.
How well it works
Success means the tumor is fully removed, the stage is known, and follow-up checks stay clear. The pathology report and your follow-up schedule guide what comes next.
- Grade and stage
The report gives the tumor's grade, how deep it grew, whether the edges are clear, and whether any lymph nodes contained cancer.
- Treatment after surgery, if needed
If the tumor grew deeply or reached lymph nodes, chemotherapy after surgery lowers the chance of the cancer coming back, based on the POUT trial. Some people are offered immunotherapy instead.
- Bladder checks
Cystoscopy every few months for the first years, because new bladder tumors are common. Most are found small and are removed with a scope.
- Scans
CT scans of the belly and chest on a schedule based on risk, and checks of your remaining kidney and ureter.
- Kidney function
Your creatinine and eGFR are checked, since you now have one kidney.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Expected for several weeks.
Common while the catheter is in.
Common while the bladder heals.
Removing a kidney lowers total kidney function. This can also limit some chemotherapy choices later.
This is a feature of the disease, not a surgical complication. It is why bladder checks continue for years.
Less common
Uncommon with keyhole surgery.
Usually heals with the catheter left in longer.
Urinary, wound or lung infection, usually treated with antibiotics.
Bloating and nausea for a few days while the bowels wake up.
Sometimes needed for scar tissue, bleeding or a difficult tumor.
Rare
The bowel, spleen, liver, large blood vessels or the lining of the lung can rarely be injured. Most injuries are repaired during surgery.
A clot in a leg vein that can travel to the lungs.
A bulge at the larger cut, sometimes months later.
Very rare if the other kidney is healthy.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- No urine draining into the catheter bag for more than 1 to 2 hours, especially with belly pain or fullness
- Thick red urine or large clots that block the catheter
- Feeling faint, a racing heart, or new severe belly or side pain
- Pain, swelling or redness in one calf, or chest pain or trouble breathing (call 911)
- Vomiting that will not stop, or a belly that keeps swelling
- Redness spreading from a cut, pus, or a cut that opens
- After the catheter is out: unable to urinate for more than 6 hours
Questions to ask your surgeon
- Is my tumor high grade or low grade, and how sure are we?
- Could my tumor be treated without removing the kidney?
- Should I have chemotherapy before surgery?
- How will you remove the bladder cuff?
- Will you remove lymph nodes?
- Will I get a dose of chemotherapy in my bladder, and when?
- How long will I have the catheter?
- What will my kidney function be with one kidney?
- Should I be tested for Lynch syndrome?
- What is my follow-up schedule for bladder checks and scans?
- How many of these operations do you do each year?
Words you may hear
- Urothelium
- The lining of the kidney's drainage system, ureters and bladder.
- Upper tract urothelial cancer (UTUC)
- Cancer of the urothelium inside the kidney or ureter.
- Renal pelvis
- The funnel inside the kidney where urine collects before flowing into the ureter.
- Ureter
- The thin tube that carries urine from the kidney to the bladder.
- Bladder cuff
- A small ring of bladder wall around the ureter's opening, removed with the ureter.
- Ureteroscopy
- A test where a thin scope is passed up the ureter to see inside it and the kidney and take biopsies.
- CT urogram
- A CT scan with dye timed to outline the kidneys, ureters and bladder.
- Grade
- How abnormal the cancer cells look. High grade means more likely to grow and spread.
- Cystoscopy
- A look inside the bladder with a thin scope through the urethra.
- Intravesical chemotherapy
- Chemotherapy placed directly into the bladder through a catheter.
- Cystogram
- An X-ray of the bladder filled with dye to check for leaks.
- Lynch syndrome
- An inherited condition that raises the risk of colon, uterine, upper tract urothelial and some other cancers.
Common questions
Why do you have to take the whole ureter and part of my bladder?
The cancer grows in the lining, and the ureter is lined the whole way down, including the short part that runs through the bladder wall. Leaving any of it behind leaves a high chance of a new tumor in that stump, which is hard to check.
Is this bladder cancer?
It is the same kind of cancer as most bladder cancers, but it started in the kidney or ureter. That is why the bladder needs regular checks afterward.
Will I need chemotherapy?
It depends on the stage. If the tumor grew deeply or reached lymph nodes, chemotherapy after surgery is usually recommended. For some high-risk tumors, chemotherapy is given before surgery, while you still have both kidneys.
Why do I need the catheter for so long?
The bladder was opened and stitched closed where the ureter was removed. The catheter keeps the bladder empty and relaxed while that repair heals, usually for about a week.
Can I live normally with one kidney?
Yes, most people do. Keep blood pressure and blood sugar controlled, avoid ibuprofen-type medicines unless approved, and have your kidney function checked regularly.
Did smoking cause this?
Smoking is the biggest known risk factor, but not the only one. Some cases are linked to certain chemicals, herbal products containing aristolochic acid, or Lynch syndrome. Stopping smoking now lowers the risk of new tumors.
Sources this page draws on
- American Urological Association and Society of Urologic Oncology, Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline (2023)
- European Association of Urology, EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma
- European Urology, ODMIT-C randomized trial: single postoperative dose of mitomycin C into the bladder after nephroureterectomy (O'Brien et al.) (2011)
- The Lancet, POUT randomized trial: adjuvant chemotherapy in upper tract urothelial carcinoma (Birtle et al.) (2020)
- Urology Care Foundation, Upper Tract Urothelial Carcinoma
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.