Nephrectomy is a common urologic procedure indicated for malignancy, certain benign conditions of the kidney and renal transplantation. Simple, radical, partial and donor nephrectomies and nephroureterectomy all have common surgical steps but have unique complications. Renal tumor ablative interventions are the more commonplace attempts to limit patient morbidity.

Simple nephrectomy is indicated for benign but not trivial conditions. Indications include non-functioning kidneys causing pain (usually from congenital obstruction or urolithiasis), reno-vascular disease causing uncontrollable hypertension, benign symptomatic tumors (angiomyolipomas), trauma, or treatment of infectious diseases (xanthogranulomatous pyelonephritis, chronic or emphysematous pyelonephritis, and tuberculosis). During simple nephrectomy, the kidney is removed within Gerota's fascia along with a small amount of ureter. Nephrectomy for inflammatory conditions can be the most exacting of procedures; medical comorbidities add to the challenge of patient management.

Donor nephrectomy is a simple nephrectomy in which a healthy kidney (usually the left because of increased vein length) is removed and transplanted as an allograft in a controlled scheduled situation. These donor patients are all healthy and have had extensive preoperative evaluations. Transplant nephrectomy is a simple nephrectomy in which the renal allograft is removed, usually because of rejection complications.

Radical nephrectomy involves the removal of all structures within Gerota’s fascia, which includes the adrenal, kidney, and peri-renal tissue. Adrenal-sparing radical nephrectomy, especially for lower pole tumors, has become commonplace because of the low incidence of ipsilateral adrenal invasion or metastases. Most renal tumors are found incidentally by CT or MRI, or during the process of hematuria screening. Upwards of 95% of enhancing renal masses are malignant; therefore, needle biopsy or pathologic proof before surgery is not routinely obtained.