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A nephroureterectomy is a surgical procedure that treats transitional cell cancer. During the procedure, a surgeon will remove your kidney, ureter and bladder cuff. Risks include healing problems, blood clots and a poor response to anesthesia. Most people fully recover from a nephroureterectomy after six weeks.
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A nephroureterectomy (NEFF-roh-yer-IT-ter-ECK-toh-mee) is a surgery that removes your:
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“Nephroureterectomy” is a big word. But what does it mean?
A healthcare provider may recommend a nephroureterectomy if you have transitional cell cancer (urothelial cancer).
A nephroureterectomy is a radical surgery. During a radical surgery, a provider removes a tumor and any other tissue or organs into which cancer may have spread (metastasized). For example, if cancer invades your large intestine (colon) or nearby lymph nodes, the provider may remove part of your colon and the nearby lymph nodes, along with your kidney and ureter.
Surgeons perform about 1,000 to 2,000 nephroureterectomies each year in the U.S.
Before a nephroureterectomy, you’ll meet with a healthcare provider. They’ll review your health history and check your general health — including your vitals (temperature, pulse and blood pressure), height and weight — to make sure you’re healthy enough for surgery. They’ll also explain the procedure to you and ask for your consent.
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Tell the provider about any prescription or over-the-counter (OTC) medications you’re taking. This includes vitamins and herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your risk of bleeding. Be sure to check with a healthcare provider before you stop or start taking any medications around the time of your surgery.
Tell the provider about any allergies you have, too. These may include:
The provider will also give you specific directions on eating and drinking before the procedure. Follow a clear liquid diet for 24 hours before surgery. You shouldn’t eat anything at least eight hours before your procedure. If you must take medications, take them with a small sip of water.
There are two main surgical approaches to a nephroureterectomy:
During a traditional open nephroureterectomy, a healthcare provider will make one to two large cuts (incisions) in your abdomen. They may also remove a rib. The first incision may be between 8 and 12 inches (about 20 and 30.5 centimeters) long. A provider may need to perform an open nephroureterectomy if a tumor is very large or difficult to reach (invasive).
Most nephroureterectomy procedures are now robot-assisted laparoscopic nephroureterectomies. A robot-assisted nephroureterectomy is a minimally invasive surgery that combines a laparoscopy with robot-assisted surgery.
A surgeon makes three to five small incisions in your lower abdomen. The incisions are only about half an inch (1.27 centimeters) long. They use a thin tool with a camera at the end (laparoscope) to see inside your body. The laparoscope provides large (magnified) views of your kidney, ureter and bladder cuff on a computer screen. The surgeon also controls a surgical robot that can skillfully handle the instruments and make precise movements in hard-to-reach areas of your body. They control the robot with a surgical console.
Surgeons usually use a robot-assisted laparoscopic approach to treat people who have transitional cell cancer in their upper urinary system or (kidneys, ureters, bladder and urethra) or transitional epithelium. Transitional epithelium is a tissue that lines your kidneys, ureters and bladder.
The best candidate for a nephroureterectomy is someone who has transitional cell cancer of the ureter or renal pelvis (the funnel-shaped structure in the center of each kidney that collects pee and passes it).
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A special team of healthcare providers will perform a nephroureterectomy. The team typically includes:
The anesthesiologist will sedate you (put you under) with general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure. A provider may also inflate your abdomen with carbon dioxide gas to create a working space for the urologist.
Once you’re asleep, the urologist will use a sharp, sterile knife (scalpel) to carefully make incisions in your abdomen. During an open procedure, they’ll make one to two longer incisions so they can see inside your abdomen and remove (extract) your affected organs.
For a minimally invasive approach, they’ll:
Finally, the urologist will use stitches (sutures) to close your incisions. They may place small silicone tubes (drainage tubes) in your incision sites. The drainage tubes drain blood and fluid. They’ll secure the tubes in place.
When a surgeon removes a kidney, they’ll cut the ureter near where it connects to the bladder and seal the area.
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On average, open and laparoscopic nephroureterectomies last about two to four hours.
After a nephroureterectomy, the anesthesiologist will stop putting anesthesia in your body to keep you asleep. At that point, you’ll start waking up.
You’ll move to a recovery room, where healthcare providers will track your overall health and wait for you to wake up more fully. They’ll also manage your pain. Anesthesia also may cause nausea. If you feel like you may throw up (vomit), providers will give you medication.
You’ll maintain a liquid diet for a day or two after surgery. A liquid diet helps give your body time to recover. After this time, providers will help you get back to eating solid foods.
The day after surgery, providers will help you get out of bed and walk. Walking helps your recovery process. It limits your risk of developing blood clots in your legs and prevents pneumonia.
Once providers determine you’re healthy enough and no longer require monitoring, they’ll let you go home (discharge you). You must have a family member or friend drive you home. It’s also a good idea to have a family member or friend help take care of you for at least a few days after the procedure.
The main benefit of a nephroureterectomy is that it treats transitional cell or upper tract urothelial cancer (UTUC), which can be deadly without treatment. The risks of living with UTUC without treatment outweigh any risks associated with a nephroureterectomy in most people.
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A robot-assisted laparoscopic radical nephroureterectomy has several advantages over open nephroureterectomy. These advantages include:
According to a 2021 study of 422 people in the U.K. who had a radical nephroureterectomy to treat upper tract urothelial cancer, the five-year survival rate is over 70% and the 10-year survival rate is over 67%.
All surgical procedures have risks. Some nephroureterectomy risks include:
Most people describe a nephroureterectomy as moderately painful.
An open nephroureterectomy is more painful than a robot-assisted laparoscopic nephroureterectomy.
A healthcare provider may prescribe pain relievers. You may also manage your pain with over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
You must rest and relax for about six weeks after a nephroureterectomy. You shouldn’t drive for at least two weeks after the procedure.
You should also avoid strenuous physical activity. This includes running and lifting objects over 20 pounds — about two gallons of water. Strenuous physical activity can strain your stitches or cause an injury or hernia. Walking as exercise is OK and even encouraged after surgery.
Your body is unique, so recovery times may vary. It’s a good idea to be aware of your body and its limitations as you recover. Follow your healthcare provider’s general guidelines on managing any discomfort or pain.
You should be able to return to work or school about four weeks after a nephroureterectomy. If you have a less physically demanding job, you may be able to return to work sooner. But it’s a good idea to schedule more time off if your job involves a lot of heavy lifting or physical activity.
Schedule follow-up appointments with a healthcare provider. They’ll want to check your incisions and stitches. If you don’t have dissolvable stitches, they may remove your stitches after a week or two. If you have drainage tubes, they’ll remove those, as well.
They’ll also conduct tests to make sure the surgery has removed all upper tract urothelial cancer. If it spreads or if your specific cancer is very high risk or aggressive, they’ll help you coordinate the next steps in your treatment plan. This may include chemotherapy or other medicines.
Contact a provider immediately if you have any abnormal symptoms. These may include:
A nephrectomy is the surgical removal of part of a kidney. A surgeon may remove only the diseased part of your kidney (partial nephrectomy), or they may remove all of it (radical nephrectomy).
A nephroureterectomy removes your kidney as well as your ureter and bladder cuff.
It’s normal to experience a lot of feelings before nephroureterectomy — stress, nerves, fear, anxiety or even pessimism. What happens if the surgery doesn’t go as planned? What happens if the cancer is in other areas of my body? What if recovery is too hard?
It’s completely normal to have these thoughts and concerns. But it’s helpful to remind yourself of the potential benefits of surgery, too, like how it may make you feel better and improve your quality of life.
A great way to center your thoughts is to learn as much as you can about a nephroureterectomy. Talk to your care team. They can answer any questions you may have and support you through the process.
If you have a condition that’s affecting your urinary system, you want expert advice. At Cleveland Clinic, we’ll work to create a treatment plan that’s right for you.
Last reviewed on 06/10/2025.
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