Diseases of the Kidney
Many types of kidney tumors exist and they may be benign or malignant. Today, most kidney tumors are diagnosed as unsuspected findings when radiographic studies are performed for medical conditions unrelated to the kidney. However, some kidney tumors may be associated with pain, hematuria (blood in the urine), a mass in the abdomen, fever, loss of weight, or other symptoms.
Benign kidney tumors include a cyst, angiomyolipoma, leiomyoma, and oncocytoma. Malignant kidney tumors include renal cell carcinoma, transitional cell carcinoma, and metastatic tumors from other organs.
Simple cysts are oval or round fluid filled structures originating from the kidney. They are the most common type of benign kidney tumor. They are more common the older a person is and approximately 50% of the population over the age of 50 years has a kidney cyst. Cysts may cause no symptoms at all or may be associated with pain or obstruction of kidney drainage. Symptomatic cysts may be treated with percutaneous or endoscopic drainage or laparoscopic or robotic removal.
In this video, laparoscopic surgical techniques are utilized to identify and surgically remove a symptomatic renal cyst.
Renal Cell Carcinoma
This is a malignant tumor accounting for a small percentage of all adult cancers. It may be diagnosed as an unsuspected finding on x-ray studies or it may be associated with any of the above mentioned symptoms. However, when it is found, treatment is usually necessary.
The standard treatment for localized tumors is usually surgical removal of either the entire kidney or a portion of the kidney. Today, many tumors of this type are treated with minimally invasive surgery, such as robotic surgery, laparoscopy, or percutaneous procedures. Renal sparing interventions are employed when possible.
It may be difficult to distinguish renal cell carcinoma from an oncocytoma, angiomyolipoma, or other kidney tumor.
Transitional Cell Carcinoma
This is a malignant tumor that can occur in the urinary bladder or collecting system of the kidney (i.e., ureter, renal pelvis). It has a strong association with tobacco use and is usually found along with blood in the urine.
Once diagnosed, these cancers can be removed or at least sampled endoscopically. Advanced or aggressive tumors in the kidney or ureter may require complete removal of a kidney which can be accomplished in a robotic, laparoscopic, or laparoscopic assisted operation. Advanced or metastatic cancers may require additional treatment which may include chemotherapy or radiation therapy.
This video demonstrates the use of endoscopic surgery to treat cancer in the upper urinary tract (i.e., renal pelvis or ureter).
In this video, laparoscopy is used to remove a right kidney for treatment of localized kidney cancer. The entire kidney is removed with ligation of the blood supply to the kidney through stapling. This type of nephrectomy is a radical nephrectomy.
Ureteropelvic Junction (UPJ) Obstruction
UPJ obstruction may occur and be present from birth or may be acquired over time. This disease process results in impaired drainage of urine from the kidney at the area where the renal pelvis joins the ureter. A UPJ obstruction may not cause any symptoms or may be associated with pain in the lower back or abdomen. “Typical” pain with this condition may worsen when the affected individual consumes a large volume of fluid.
Treatment is warranted for a UPJ obstruction when there is confirmed pain caused by the obstruction, kidney drainage is so impaired that infections occur or stones form, or when there is compromise of kidney function.
Options for treatment include endoscopic, robotic/laparoscopic operations, or open surgery. Usually a ureteral stent is necessary for a short period of time after the procedure (see section on urinary tract stones).
This video demonstrates the endoscopic incision of an obstructed ureteropelvic junction using laser energy.