When irreversible damage to your kidneys prevents them from functioning enough to support your body’s needs, your doctor may recommend a bilateral nephrectomy. This is the surgical removal of both kidneys.

A nephrectomy is the full or partial removal of a single kidney. It’s performed when your kidney is too damaged to function properly or when you donate a kidney.

Full kidney removal is called a radical or simple nephrectomy. Surgery that removes only part of the damaged kidney is called a partial nephrectomy.

When both kidneys are severely damaged, partial or simple nephrectomies are no longer options. Without a functioning kidney that can work solo, a surgeon removes both kidneys by way of a bilateral nephrectomy.

Having both kidneys removed is a major surgery. It’s typically done only when other treatments do not work. It requires a kidney transplant from a donor or another form of renal replacement therapy after surgery.

A bilateral nephrectomy is the complete surgical removal of both kidneys.

It’s performed when the kidneys are too damaged to meet your body’s needs and neither kidney is functional enough to take on additional workload if the second kidney is removed.

Unlike a simple nephrectomy, which may not require a kidney transplant or follow-up renal therapy, supplemental renal support is necessary for survival when both kidneys are removed.

This factor, plus the complexity of the surgery, is why bilateral nephrectomies are only performed as the last option when all other treatments are no longer practical.

Conditions that may lead to a bilateral nephrectomy include:

Your surgeon performs a bilateral nephrectomy laparoscopically or through open surgery, also known as classic retroperitoneal surgery.

Your surgical team will use general anesthesia, which means you’ll be fully unconscious. Oxygen and anesthetic are delivered to your lungs through a tube down your throat to keep you asleep.

Laparoscopic procedures are done by making small incisions in the abdomen. This technique gives laparoscopy its nickname of “keyhole surgery”: The openings are just large enough for your surgeon to insert the lighted laparoscope and specialized surgical tools.

To help improve visibility and create working space for your surgeon, your abdominal cavity is inflated with carbon dioxide (CO2). This harmless gas is expelled before your incisions are closed. Any remaining CO2 naturally dissipates in the body after a few days.

While laparoscopy is associated with benefits like faster surgical time and improved recovery postsurgery, your individual circumstances might warrant open surgery for your bilateral nephrectomy.

Open surgery involves a large incision down the midline of your abdomen. Surgical tools hold open the incision to provide working space and a clear view of the entire abdominal cavity.

Many people having a bilateral nephrectomy are also receiving a donor kidney. While a donor kidney can be placed laparoscopically, the procedure is intricate and complex.

Many surgeons opt for open surgery so they have increased surgical access and an open view of the entire surgical site.

How long does a bilateral nephrectomy take?

The exact amount of time for a bilateral nephrectomy depends on many factors, including the conditions that led to kidney damage, your overall health, and what your treatment plans are for renal replacement.

A 2020 research paper reporting on seven bilateral nephrectomies using an open method found the procedure ranged between 2.5 hours and 4 hours, with an average of 2 hours and 10 minutes.

Once your kidneys are removed, placing a donor’s kidney can extend surgery time by 4 hours or longer.

The days and weeks before a bilateral nephrectomy involve a variety of preparations. Your doctor conducts different laboratory tests, such as:

  • ultrasound
  • urinalysis
  • ionogram, which measures ion levels in the blood
  • blood work to assess kidney function
  • blood clotting evaluation
  • morphology, which views the structure of your cells under a microscope

These tests provide insight into your overall surgical risk and the condition of your kidneys.

The day before the bilateral nephrectomy, you may need to undergo dialysis. This procedure filters waste products from your blood. It takes some of the burden off your renal system while you undergo surgery.

The day before surgery, your care team will also give you special instructions regarding when and what you can eat, necessary hygiene procedures, and how to adjust any current medications you’re taking.

You might not feel up to making home care or transport arrangements after your procedure, so having these plans in place beforehand is advised.

Wearing loose, comfortable clothing on the day of your surgery is usually recommended.

Once your surgery is done, you recover in a warm, quiet area where the surgical team can closely monitor your vitals and functions associated with renal health, like your blood pressure.

It’s standard to have a urinary catheter to keep your bladder drained immediately after surgery. This prevents discomfort and unnecessary pressure on your renal system.

Surgical site pain is common, especially for the first week after surgery. If you had a laparoscopic procedure, you might notice sharp or shooting pain in your shoulder and chest area. This can be a side effect of leftover CO2 moving around before dissipating.

Most people can expect a multiday hospital stay. Your care team wants to ensure your renal system is functioning properly and that your body is accepting any transplanted kidneys before you go home.

According to a single-center retrospective study from 2021, out of 142 people evaluated, the average hospital stay post-bilateral nephrectomy was 8 days.

During your hospital recovery time, you may have more dialysis procedures. For some people, dialysis becomes a regular part of life.

For those who received a kidney transplant, dialysis filters the blood until the new kidney becomes functional. This may take weeks.

How long is the recovery process for a bilateral nephrectomy?

Your recovery time depends on your overall health, coexisting conditions, and the amount of support you have access to after leaving the hospital.

While you may be able to start regular activities at the 6-week mark postsurgery, full recovery can take a year or longer.

Bilateral nephrectomy is a lengthy, complex procedure. It comes with standard surgical risks, such as:

Complications specifically associated with the removal of the kidneys include:

The survival rate of bilateral nephrectomy depends on multiple factors. Your overall health, the reasons for kidney damage, and the success of renal replacement therapy are just a few variables that can affect your life span.

The bilateral nephrectomy procedure itself has gotten safer over the years. In 1978, the overall mortality rate after surgery was 3.6% for people under 50 years old and 11.1% for people over 50 years old.

More recent statistics from a 2017 study found an average 30-day mortality rate of 0.5% across multiple types of nephrectomy surgeries.

A bilateral nephrectomy is a surgical procedure that removes both kidneys. It’s performed when the kidneys are so damaged that neither can function alone if the other is removed.

If you’re having a bilateral nephrectomy, your doctor will discuss renal replacement therapy or a kidney transplant with you.

Bilateral nephrectomy has a low death rate. Your overall survival rate depends on factors like your current health, underlying disease processes, and the success of renal therapies.