The kidneys are two small fist-sized organs located behind the abdomen on each side of the spine. By producing urine, kidneys remove toxic by-products and excess fluids from the body to help maintain a critical balance of salt, potassium and acid.

Diseases of the kidney are found more often in racial and ethnic minority populations in the United States than in the Caucasian population. African Americans, Asian Americans, Hispanics/Latinos, and Pacific Islander Americans are three times more likely to suffer from kidney failure than Americans of European descent.

Blockage of the ureter

Kidney cancer

Therapeutic options

Urologic sypmtoms

Blockage of the Ureter

One of the most common conditions affecting the kidneys is blockage of the ureter – the tubes that transport urine from the kidneys to the bladder. This condition is found in adults, but more commonly in children.

Normally, a single ureter drains a single kidney but sometimes there may be two ureters draining one kidney. One ureter drains the upper part of the kidney and the second ureter drains the lower part. As long as they both enter the bladder normally, this “duplicated collecting system” is not a problem.

In rare cases, a child may be born with an ectopic (abnormally positioned) ureter. This is a ureter that fails to connect properly to the bladder and drains somewhere outside the bladder. In girls, the ectopic ureter usually drains into the urethra or even the vagina. In boys, it usually drains into the urethra near the prostate or into the genital duct system. The urethra is a canal that carries the urine from the bladder and in males also serves as a passageway for semen.

The most common cause of blockage in the urinary tract in children is a congenital obstruction at the point where the ureter joins the renal pelvis — the ureteropelvic junction (UPJ) – the area at the center of the kidney where urine collects and is funneled into the ureter. This problem occurs in roughly one in 1,500 children.1 These obstructions develop prenatally as the kidney is forming. Today, most cases are diagnosed on prenatal ultrasound screening. In UPJ obstruction, the kidney produces urine at a rate that exceeds the amount of urine able to drain out of the renal pelvis into the ureter. This causes an accumulation of urine in the kidney. This accumulation, also called hydronephrosis. It is visible on ultrasound and often allows the doctor to predict the presence of UPJ obstruction before the baby is born.

Although less common in adults, UPJ obstruction maybe caused by kidney stones, previous surgery(ies) or disorders that cause inflammation of the upper urinary tract.

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Kidney cancer

Kidney cancer can form in the small tubes inside the kidney. Those tubes are located in the center of the kidney where urine collects and used to filter blood. Each year, kidney cancer is diagnosed in about 190,000 people worldwide.1 Kidney cancer is slightly more common in men and is usually diagnosed between the ages of 50 and 70 years.2 The most common kidney cancer is called renal cell carcinoma.

It is important to realize that with early diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent.3

1.World Health Organization; Global cancer rates could increase by 50% to 15 million by 2020; URL: http://www.who.int/mediacentre/news/releases/2003/pr27/en/2.“Cancer Facts & Figures 2008”, American Cancer Society, www.cancer.org , URL: http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

3.‘Kidney Cancer”, American Urological Association Foundation, www.urologyhealth.org

4.Bhayani SB, Das N.; Robotic-assisted laparoscopic partial Nephrectomy for suspected Renal Cell Carcinoma. BMC Surgery 2008, 8:16 doi:10.1186/1471-2482-8-16

5.Huang WC, Elkin EB, Levey AS, Jang TL, Russo P; Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is there a Difference in Mortality and Cardiovascular Outcomes; The Journal of Urology, Vol. 181, 55-62, January 2009

6.Ramaswamy M. and Sundaram CP.; Laparoscopic live-donor nephrectomy. University Hospital, Liverpool, UK, and Indiana University Hospital, Indianapolis, USA. January 2006

7.Nazemi T; Galich A, et al. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods. Int. braz j urol. vol.32 no.1 Rio de Janeiro Jan./Feb. 2006

8.Ibid.

9.Renoult E, Hubert J, et al. Robot-assisted laparoscopic and open live-donor nephrectomy. Nephrology Dialysis Transplantation 2006 21(2):472-477

10.Ibid.

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Therapeutic options

Nononcological kidney conditions such as ureteral blockage can usualy be treated by the removal of the obstacle. According to the kynd of blockage surgical treatment can be used.

On the other hand, kidney cancer is frequently resistent to radiotherapy or chimiotherapy, thus the golden standard for kidney cancer is the surgical removal of the kidney or of the tumor.

Open kidney surgery involves a big abdominal incision. conventional laparoscopic surgery, althought less invasive is limited by the doctors dexterity, filed of view and difficult control.

da Vinci surgery for kidney conditions

If your doctor recommends surgery for kidney cancer, you may be a candidate for a new, minimally invasive approach — da Vinci® Surgery. da Vinci Surgery uses state-of-the-art technology to help your doctor perform a more precise operation than conventional surgery. It offers several potential benefits over conventional open surgery, including:

  • Increased potential to spare healthy kidney tissue and minimize the risk of chronic kidney disease 4,5
  • Significantly less pain6
  • Less blood loss than open and traditional laparoscopic surgery7
  • Fewer blood transfusions8
  • Less risk of infection9
  • Shorter hospital stay and recovery 10
  • Less scarring6

da Vinci Surgery for kidney cancer incorporates the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach.

The precision and dexterity of the da Vinci Surgical System’s advanced instrumentation facilitates a minimally invasive approach for treating kidney cancer.

As with any surgery, these benefits cannot be guaranteed, as surgery is patient and procedure specific.

If you are a candidate for kidney surgery, talk to a urologist who performs da Vinci kidney procedures. To find a da Vinci urologic surgeon, use our surgeon locator.

* In Nephrectomy, one incision is enlarged for removal of the kidney.

1.World Health Organization; Global cancer rates could increase by 50% to 15 million by 2020; URL: http://www.who.int/mediacentre/news/releases/2003/pr27/en/
2.“Cancer Facts & Figures 2008”, American Cancer Society, www.cancer.org , URL: http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
3.‘Kidney Cancer”, American Urological Association Foundation, www.urologyhealth.org
4.Bhayani SB, Das N.; Robotic-assisted laparoscopic partial Nephrectomy for suspected Renal Cell Carcinoma. BMC Surgery 2008, 8:16 doi:10.1186/1471-2482-8-16
5.Huang WC, Elkin EB, Levey AS, Jang TL, Russo P; Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is there a Difference in Mortality and Cardiovascular Outcomes; The Journal of Urology, Vol. 181, 55-62, January 2009
6.Ramaswamy M. and Sundaram CP.; Laparoscopic live-donor nephrectomy. University Hospital, Liverpool, UK, and Indiana University Hospital, Indianapolis, USA. January 2006
7.Nazemi T; Galich A, et al. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods. Int. braz j urol. vol.32 no.1 Rio de Janeiro Jan./Feb. 2006
8.Ibid.
9.Renoult E, Hubert J, et al. Robot-assisted laparoscopic and open live-donor nephrectomy. Nephrology Dialysis Transplantation 2006 21(2):472-477
10.Ibid.

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 Urologic conditions – syptoms

Blockage of the Ureters – Symptoms

A blockage of the ureters (tubes that carry urine from the kidneys to the bladder) may not cause any symptoms. The blockage may allow the affected kidney to function normally, even though the kidney is not in its normal position. Many people do not discover they have this condition until they have tests for other reasons. Sometimes, a doctor may feel a lump in the abdomen during a routine exam. In other cases, the blockage may cause abdominal pain or urinary problems.

When a kidney is out of its normal position, urine drainage problems are common. Sometimes, urine can even flow backwards from the bladder to the kidney. This is called vesicoureteral reflux. Abnormal urine flow can cause many other problems and symptoms such as:1,2
Infection

Normally, urine flow washes out bacteria and keeps them from growing in the kidneys and urinary tract. When a kidney is out of its normal position, urine can get trapped in the ureter or in the kidney itself. Urine that remains in the urinary tract gives bacteria the chance to grow and spread. Symptoms of a urinary tract infection include frequent or painful urination, back or abdominal pain, fever, and chills. The urine may be cloudy or have an unusual smell.
Stones

Urinary stones form from substances found in the urine, such as calcium and oxalate (a salty substance). Urine that stays too long in the urinary tract increases the risk that these substances will have time to form stones. Symptoms of urinary stones include extreme pain in the back, side, or pelvis; blood in the urine; fever or chills; vomiting; and burning during urination.
Kidney failure

If urine backs up all the way to the kidneys, damage to the kidneys can occur. As a result, the kidneys cannot filter waste and extra fluid from the blood. Symptoms of kidney failure include swelling in the legs or abdomen, feeling very tired, headaches, or nausea. If total kidney failure occurs, you will need dialysis or a kidney transplant. Total kidney failure happens only when both kidneys are damaged. One ectopic (out of place) kidney, even when it is not functioning, won’t cause kidney failure.
Trauma

If the ectopic kidney is in the lower abdomen, or pelvis, it may be susceptible to injury from blunt trauma. People with an ectopic kidney who want to participate in body contact sports may want to wear protective gear.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

“Ectopic Kidney”, National Kidney and Urologic Diseases Information Clearinghouse, www.kidney.niddk.nih.gov , URL: http://kidney.niddk.nih.gov/kudiseases/pubs/ectopicKidney/index.htm
“Adult Conditions: Kidney Cancer”, American Urological Association Foundation, www.urologyhealth.org

Symptoms of Kidney Cancer

Unfortunately, kidney cancer does not have early symptoms but you should see your doctor if you notice the following:1

  • Blood in your urine
  • Lump in your abdomen
  • Unexplained weight loss
  • Pain in your side
  • Loss of appetite

If cancer spreads (metastasizes) beyond the kidney, symptoms depend on the organ involved. Shortness of breath or coughing up blood may occur when cancer is in the lung. Bone pain or fractures may occur when cancer is in the bone. When cancer is in the brain, you may have neurologic symptoms.

In some cases, kidney cancer causes related conditions called paraneoplastic syndromes. These syndromes occur in about 20 percent of kidney cancer patients and can occur in any stage, including cancers confined to the kidney. Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. In many cases, the paraneoplastic syndrome improves or disappears after the cancer is removed.

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While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.1.”Ectopic Kidneys”, National Urological Association Foundation, www.urologyhealth.org

2.”Ectopic Ureter”, American Urological Association Foundation, www.urologyhealth.org , URL: http://www.urologyhealth.org/pediatric/index.cfm?cat=01&topic=71

3.Hemal AK, Mukherjee S, Singh K; Laparoscopic pyeloplasty verus robotic pyeloplasty ureteropelvic junction obstruction: a series of 60 cases performed by a single surgeon.

4.Olsen LH, Jorgensen TM; Computer Assisted Pyeloplasty in Children: The Retroperitoneal Approach; The Journal of Urology, Vol. 171, 2629-2631, June 2004