Medical Oncologist
CION Cancer Clinics
Nephroureterectomy: what is actually removed | CION Cancer Clinics
A nephroureterectomy removes the whole kidney on one side, the entire tube that carries urine from that kidney to the bladder (the ureter), and a small ring of bladder wall where that tube enters. Nearby lymph nodes are sometimes taken as well. The adrenal gland, the other kidney and the rest of the bladder stay. This page walks through each part, why it goes, and what is left behind. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What exactly is removed in a nephroureterectomy?
- The parts that come out, one by one
- What is removed, and what stays
- How does the surgeon take it out?
- Four things families believe about this operation
- Who does this operation not suit, and what can this page not tell you?
- Common questions about what a nephroureterectomy removes
The short answer
What exactly is removed in a nephroureterectomy?
Three things come out in one operation: the kidney on the affected side, the ureter (the tube that carries urine from that kidney to the bladder) along its whole length, and a small cuff of bladder wall around the point where the ureter enters. All three are removed together, in one piece.
Why all three, and not just the tumour
The cancer this operation treats grows in the lining of the urinary tract, called the urothelium. It is the same lining that bladder cancer grows in, and it runs as one continuous sheet from the inside of the kidney down to the bladder. Loose cancer cells float downstream with the urine and can settle anywhere along it. Taking the whole length removes every part of the lining the tumour could have seeded.
What the operation is for
It is the standard operation for cancer of the renal pelvis (the funnel inside the kidney where urine collects) and of the ureter, when the tumour is high grade, large, or cannot be treated safely through a telescope. Your surgeon will call this upper tract urothelial cancer. It is not the operation for the common kidney cancer that grows in the kidney tissue itself. That is a nephrectomy, and there the ureter usually stays.
This page describes what the operation removes. It does not tell you whether you need it. That decision belongs to your treating team.Part by part
The parts that come out, one by one
Each part goes for a reason.
The kidney
The whole kidney on the affected side is removed, with the layer of fat around it. The tumour usually sits in the collecting system inside the kidney, so the two cannot be separated.
Usually left behind
- The adrenal gland above the kidney
- The other kidney, untouched
The whole ureter
The ureter is followed from the kidney down into the pelvis and freed along its full length. A stump left behind is a piece of the same lining that cannot easily be checked later, and it is where cancer tends to return.
The bladder cuff
The last part of the ureter runs inside the bladder wall before it opens into the bladder. A small ring of bladder around that opening is cut out with it, and the bladder is stitched closed.
The rest of the bladder stays and works as before.Lymph nodes, sometimes
Lymph nodes are small glands that filter fluid from nearby tissue, and cancer can reach them first. For deeper tumours your surgeon may remove the nodes near the kidney so the pathologist can check them.
Depends on
- Where the tumour sits
- How deep it looks on the scan
Not sure whether this applies to you?
Ask an oncologistSide by side
What is removed, and what stays
Comes out
Stays
The kidney on the affected side, with its surrounding fat
The other kidney, which takes over the work
The whole ureter on that side, down to the bladder
The ureter on the other side, untouched
A small cuff of bladder wall around the ureter opening
The rest of the bladder, which keeps storing and passing urine normally
Nearby lymph nodes, in some cases
The adrenal gland, unless the tumour has reached it
Nothing from the bowel, liver or spleen
These organs are moved aside during surgery, not removed
In the theatre
How does the surgeon take it out?
Anaesthetic and position
You are fully asleep under a general anaesthetic, placed partly on your side so the surgeon can reach the kidney and later the bladder without moving you again.
Freeing the kidney
Through one larger cut or several small keyhole cuts, the surgeon moves the bowel aside, seals the artery and vein to the kidney, and frees the kidney with its fat. Ask your surgeon which approach is planned for you.
Following the ureter down
The ureter is traced from the kidney down into the pelvis, freed from the tissue around it, and kept attached to the kidney so the whole specimen stays in one piece.
Taking the bladder cuff
The last part of the ureter, with a ring of bladder wall, is cut out. The opening in the bladder is closed with stitches or staples. A catheter is left in so the bladder can rest while it heals.
Removing the specimen and closing
Kidney, ureter and cuff come out through one cut. A drain may be left for a short time. The whole specimen goes to the pathologist, who reports on it over the following week or two.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
Four things families believe about this operation
"They are taking out the bladder as well."
No. Only a small cuff of bladder wall around one ureter opening is removed. The bladder is closed, heals, and works as before. Removing the whole bladder is a different operation.
"If it is keyhole surgery, they remove less."
The same kidney, ureter and cuff come out whichever way the surgeon gets in. Keyhole surgery changes the size of the cuts and often the speed of recovery. It does not change what is removed.
"One kidney cannot cope. He will need dialysis."
Most people live a full life with one healthy kidney, and dialysis is not part of the usual plan. What matters is how well the other kidney works, which your team checks with a blood test and a scan before recommending the operation.
"The tumour is only in the ureter. Why lose a healthy kidney?"
Because the kidney and ureter share one lining, and that lining is where the cancer lives. For some small, low-grade ureter tumours the kidney can be kept. For high-grade disease, removing the whole tract lowers the chance of the cancer returning on that side.
Being straight with you
Who does this operation not suit, and what can this page not tell you?
This operation is not offered to everyone with an upper tract tumour. If you have only one working kidney, or if both kidneys are weak, losing one could mean dialysis, and your team will look hard at kidney-sparing treatment first. Small, low-grade, single tumours can often be treated through a telescope with a laser instead.
When the operation is not the right first step
If the scan shows the cancer has spread beyond the kidney and ureter, surgery on its own does not deal with the disease, and chemotherapy may come first or instead. If your heart or lungs are not strong enough for a long anaesthetic, the team may recommend a different path.
What the operation note cannot tell you
The operation note lists what was removed. It does not tell you the stage, whether the cancer will return, or whether you will need further treatment. Those answers come from the pathology report and the follow-up plan your team builds on it.
What to ask at your next appointment
Ask whether lymph nodes will be removed, and why. Ask whether keyhole or open surgery is planned, how well your other kidney is working, and whether chemotherapy before or after surgery is being considered.
Bring the son or daughter who will be helping with decisions.Questions we are asked
Common questions about what a nephroureterectomy removes
Is the adrenal gland removed with the kidney?
Usually not. The adrenal gland sits on top of the kidney but is a separate organ with its own blood supply. It is left in place unless the scan shows the tumour has grown into it, which is uncommon. Your operation note will say if it was taken.
Why is the whole ureter removed and not just the part with the tumour?
Because the lining of the ureter is one continuous sheet with the lining of the kidney, and cancer cells travel down it with the urine. A leftover piece of ureter is hard to check with a telescope and is a common place for the cancer to come back.
Will I have a catheter afterwards, and for how long?
Yes. Because a small piece of the bladder wall is removed and stitched closed, a catheter is left in so the bladder can heal without stretching. It usually stays for about a week. Some centres check the repair with a dye X-ray before removing it.
Can the kidney be kept and only the ureter removed?
Sometimes. For a single, small, low-grade tumour in the lower ureter, the affected segment can be cut out and the ureter rejoined to the bladder, keeping the kidney. This is not offered for high-grade or multiple tumours because the chance of the cancer returning is too high. Ask your team whether you are a candidate.
Are lymph nodes always taken out?
No. Node removal is usually added for tumours that look deep or high grade on the scan and biopsy, because those are the ones most likely to have reached the nodes. For small, low-grade tumours it is often left out. Ask your surgeon what is planned for you.
How big will the scar be?
It depends on the approach. Keyhole surgery leaves several small cuts plus one slightly longer cut, often low in the abdomen, through which the kidney is lifted out. Open surgery leaves one longer cut along the flank or abdomen. Ask your surgeon to show you where the cuts will be.
Will my other kidney be enough on its own?
For most people, yes. A single healthy kidney can do the work of two. Before surgery your team checks your blood creatinine and often does a scan that measures each kidney separately. If the other kidney is weak, they will tell you before anything is decided.
What happens to the tissue that is removed?
The whole specimen goes to a pathologist, who examines it under a microscope and reports the type, grade, depth and margins of the tumour, and any lymph nodes. That report, not the operation itself, decides whether you need chemotherapy afterwards and how often you will be checked.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- National Cancer Institute — Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ) - Patient Version
- Cancer Research UK — Kidney cancer
- American Cancer Society — Bladder cancer
- NHS — Kidney cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why the whole ureter and bladder cuff come outThe reasoning behind taking the full lengthKidney-sparing surgery for upper tract tumoursWhen the kidney can be keptKidney function after nephroureterectomyLiving with one kidneyThe pathology report after surgeryWhat the report on the removed tissue meansNephroureterectomy cost in HyderabadIndicative ranges and what schemes cover
Talk to us
Been told you need this operation?
Send us the scan and biopsy report, or call the helpline. A surgical oncologist will go through what is planned and what to ask your team. One helpline serves every CION centre.