Morbidity of flank incision for renal donors

To analyze the short and long-term morbidity of flank incision in renal donors. The flank incision has been widely used by urologists for decades, and its morbidity has always been an issue.

A questionnaire assessing the morbidity and quality of life was sent to the last 100 living donors at our institution. All operations had been performed through the flank approach. Fifty-two questionnaires were returned. The mean age was 45 years. The mean follow-up was 29.5 months (range 7 to 58). The questionnaire was composed of questions regarding pain, cosmesis of the incision, and quality-of-life issues after surgery.

No patients had any major postoperative complications. Pain was described in the first postoperative day as severe, moderate, or mild by 36 (69.3%), 6 (11.5%), and 10 (19.2%) patients, respectively. On the day of discharge (mean 4 days), 17 patients (32.7%) reported severe pain. Pain was completely or somewhat controlled with analgesics after surgery in all but 3 patients. Most (81%) discontinued pain medication by the end of fourth postoperative week (54% by the end of second week). Only 3 patients (5.8%) related being very bothered by the incision at the time of the questionnaire. Bother relates to pain, location, length, and unsightliness of scar. In 43 patients (83%), the incision did not impact negatively on their self-esteem and quality of life, and 93% of patients in retrospect would undergo the same procedure without any reservation.

The short and long-term morbidity of the flank incision for living donor nephrectomy is acceptable. Most patients are content after the kidney donation, and all would undergo the same procedure all over again, the vast majority without any reservation.