Ap 5.1 Case Study

5.1 Common Complications
RNU may predispose a patient to complications such as pneumonia, hypertension, and acute renal insufficiency. The risk of pneumonia may be higher after renal surgery compared with other abdominal procedures, as patient’s postoperative pain with deep breathing may be substantial, leading to atelectasis and pneumonia. Early ambulation, incentive spirometry and adequate pain control should be encouraged in immediate postoperative period (17). The incidence of postoperative hypertension is <8%, usually mild, and it often resolves. Postoperative acute renal insufficiency may be multifactorial, relating to removal of an affected kidney, direct or indirect manipulation of the contralateral kidney, and rhabdomyolysis related to patient positioning. Postoperative acute renal insufficiency is usually brief but may need dialysis in rare cases. Long-term renal insufficiency is of minimal concern in patients with normal contralateral kidneys (17).

5.2 Venous thromboembolism
Venous thromboembolism (VTE) which includes deep venous thrombosis (DVT) and/or pulmonary embolism (PE) is an important postoperative complication that can be potentially life threatening after any urologic surgery. Postoperative DVT has been reported in 0.13% to 1.3% of patients, and
Risk factors include preoperative urinary tract infection, entry into gastrointestinal organs, entry into kidney parenchyma or collecting system, and postoperative renal hematoma. Adequate irrigation, prophylactic antibiotics, and surgical drain placement minimize the risk of abscess formation (17). In the presence of risk factors for infection, unexplained postoperative fever or leukocytosis should prompt a CT of the abdomen and pelvis to look for an abscess. Treatment involves percutaneous drainage and empiric antibiotics. Antibiotic coverage is adjusted when culture and sensitivity results become