ABSTRACT
The indications for nephrectomy are malignancy, transitional-cell carcinoma of the ureter requiring nephro-ureterectomy, non-functioning kidney, and chronic pyelonephritis complicated by infection or hypertension. The commonest presenting symptom is haematuria, which may be associated with a palpable mass in the loin. A new varicocoele increasing in size is a classic sign of renal carcinoma in men, particularly on the left side where the left gonadal vein is obstructed as it drains into the left renal vein. A chest X-ray and bone scan should be requested to detect distal metastases. The approaches that can be used to perform a nephrectomy are posterio-lateral approach and laparoscopic approach. The patient is positioned laterally, with a renal bridge on the operating table under the contralateral loin. A subcostal incision is made following the line of the twelfth rib, starting in the midline and finishing in the posterior axillary line.
