CODE: 15.1 - The simplified technique of laparoscopic nephropexy using retroperitoneal approach
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Marcin Słojewski, Adam Gołąb, Andrzej Sikorski

Katedra i Klinika Urologii PAM w Szczecinie

summary

Introduction. Nephroptosis is characterized by descent of the kidney due to its insufficient fixation in physiological location. It usually occurs in asthenic women and the right kidney is affected in 70% of cases. The diagnosis is established on the basis of symptoms and urography when the kidney in erect position is displaced downward more than two vertebral bodies or 5 cm. Since the first nephropexy was performed by Hahn in 1881, more than 150 different operative techniques and modifications of nephropexy have been described.

Objectives. The aim is to present the simplified technique of laparoscopic nephropexy using retroperitoneal approach in the treatment of symptomatic nephroptosis.

Materials and methods. Between January 2003 and December 2005 13 female patients, ranging in age from 20 to 58 years (av. 39) underwent laparoscopic nephropexy (LN). In twelve cases right kidney was operated, in one case operation was performed on left, solitary kidney. Only the patients with a bothersome and intensive pain symptoms and visualized on urography kidney descent were qualified to the operation. Following induction of general anesthesia patient is placed in a flank position. A first incision is made 2cm below the 12th rib. Muscles are bluntly dissected and the peritoneum is pushed away. To extend the working space the ballon filled with saline is used. The next two trocars, 10mm on the right and 5mm on the left side, are introduced under finger guidance. After longitudinal incision of Gerota's fascia kidney is dissected and completely mobilized with visualization of vascular pedicle and the renal pelvis. The posterior surface of the kidney is then fixed to the psoas muscle with nonabsorbable suture. The second suture is place in the same manner 2-3 cm below. The drainage is usually not necessary.

Results. The operation time was 35 to 90 minutes (av. 70). There were no intra or postoperative complications in any of the patients. The blood loss was only of trace amounts in all cases. The postoperative hospital stay was 2 days (range 1-4). The results of effect of LN on quality of life before and after the operation are presented in a separate paper.

Conclusions. 1. The introduction of LN has changed the attitude to the problem of symptomatic nephroptosis. 2. The simplified technique of LN is effective and safe procedure. 3. The indication for LN should be limited only to selected cases. The center's experience and equipment should be also taken into consideration.