Editing Open Kidney Surgery (section)

==== Complications ====

* '''Urinary fistulae'''
** PNs that involve of the collecting system increase the possibility of urinary leakage.
** Most urinary fistulae present themselves in ≈1 week postoperatively; in cases of deep renal resections, it is advisable to keep the closed suction abdominal drain in place for 7-10 days.
** '''In the case of an unrecognized or delayed urinary leak, the presence of an adjacent urinoma will prevent fistula closure and predispose the patient to infection/abscess formation.'''
*** '''Percutaneous drainage of the urinoma is the preferred method used to control an unrecognized or delayed pyelocutaneous fistula.'''
**** To further maximize drainage, consider a double-J ureteral stent that is placed after retrograde pyelography and (3) a Foley catheter to keep the entire collecting system at low pressure.
*** Most fistulas resolve within 4 to 6 weeks with conservative management, and reoperation is rarely required.
* '''Postoperative bleeding'''
** Delayed bleeding can occur following partial nephrectomy
** Usually, bleeding segmental and subsegmental arteries can be selectively embolized and the kidney salvaged without need for complete nephrectomy.
** Life-threatening hemorrhage can also occur and require complete angioinfarction of the kidney or reoperative exploration.
* '''Renal insufficiency'''
** While most cases of postoperative renal insufficiency are mild and temporary, some cases require hemodialysis for electrolyte and fluid management. Hyperfiltration injury can also cause a gradual decrease in renal function over time, typically associated with proteinuria.
** The medullary thick ascending limb of Henle is most sensitive to ischemic damage.