ABSTRACT
Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN). Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.
ABSTRACT
Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.
ABSTRACT
Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.
ABSTRACT
Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.
ABSTRACT
Horse-shoe kidney is a congenital anomaly which is associated with calculous formation and pelviureteric junction obstruction due to the abnormal lie of the pelvis and ureters. The patient presents as pain in abdomen, recurrent urinary tract infection, lump in abdomen, haematuria and pyuria. Division of the isthmus and simultaneous nephropexy corrects the lie of the pelvis and ureters and is recommended as the surgery for symptomatic horse-shoe kidney. If the pelviureteric junction is dependent and funnel shaped, simple nephropexy in lower polar diversion position will suffice but if there is high insertion of the ureter, some form of pyeloplasty is mandatory. A contralateral nephropexy, at a later stage, is also recommended.
ABSTRACT
For the past two years, nephropexy using PCN was underwent in 9 cases of nephroptosis (8 patients) with variable degrees of flank pain. All were female and 6 on right, 1 on left and 1 on bilateral. All patients had a very mobile kidney and exact distance of movement measured on the film was greater than 6cm (6 to 15 cm). After this operation, 14-20 Fr. nephrostomy catheter was indwelled for about two weeks. All patients were followed at least 3 months(3 to 32, median 17 months). We followed the patients with symptom relief and IVP after 3 months. Nephropexy was regarded as success if she remained asymptomatic for more than 3 months. Five cases were successful and four cases felt recurrent flank pain within 1 month after the surgery. Among four cases of recurrence, one had repeated PCN and got successful result, another had open nephropexy and the others have been followed so far So overall success rate was 67% (6/9). In conclusion, nephropexy using PCN is less invasive, needs shorter period of admission and leaves ignorable scars postoperatively. Furthermore it can be repeated even in the case of failure or recurrence, which would make this new technique available as the first step for the surgical treatment of nephroptosis. And the success rate could be increased if the nephrostomy tract is dilated upto 30 Fr. and the PCN catheter is placed about 4 weeks.
Subject(s)
Female , Humans , Catheters , Cicatrix , Flank Pain , Kidney , Nephrostomy, Percutaneous , Pregnenolone Carbonitrile , RecurrenceABSTRACT
The nephroptosis is a downward displacement of kidney beyond the normal range of mobility which may cause urinary tract infection, flank pain, nausea and vomiting. In patients who develop symptoms may require nephropexy or empirical supporting treatment with abdominal belt. Since the ordinary method of nephropexy and bring renal capsular tearing, we designed a method of transfixing sutures to the upper and lower poles of kidney to quadratus lumborum muscle in order to prevent renal capsular damage. Herein, we present 3 cases of nephropexy by applying transifixing modified method to those who developed severe symptoms with satisfying results.
Subject(s)
Humans , Flank Pain , Kidney , Nausea , Reference Values , Sutures , Urinary Tract Infections , VomitingABSTRACT
Objective:To study the indicators and operative method of retroperitoneal laparoscopic nephropexy.Methods: From August2001to June2003,8patients with nephroptosis underwent retroperitoneal laparospic nephropexy.All cases were women with an average age of34years(range26-45years).Five cases involved the right kidney,2on the left and1on the both.The presurgical symptoms included constant and recurring pain in8cases,upper urinary infections in6,hematuria in 5,upper tract obstruction in4.A retroperitoneoscopic procedure was performed after positioning the patient in the flank posi-tion.The decisive part was complete exposure exposure within Gerota'fascia to mobilize potential adhesions or the colon,espe-cially to pull inferior blood vessel of the kidney.Nephropexy was performed between the fibrous capsule of the lower pole of the kidney and the dissected psosa muscle using3sutures placed by intracorporeal or extracorporeal technique.Results:The mean operative time was125min(range115-240min);the mean post-operative hospital stay was9d,and the mean bedrest time was7d.During a mean follow-up of12months(range3-20months),1patient complained of recurrent pain,and there was1hematuria.No patient had further episodes of pyelonephritis or upper tract obstruction.IVP revealed kidneys in the af-fected part were in the normal region and greatly improved.Conclusion:Retroperitoneal laparoscopic nephropexy has less trauma,less post-operative discomfort and quicker recovery.It should be considered as the first choice for nephroptosis.[
ABSTRACT
Method of nephropexy: Posterior vertical skin incision 5-6 cm of length, longitudinal incision of posterior lumbar fascia, medial retraction of erector spinae muscle, parallel incision with transverse muscle and medial retraction of quadratus lumborurn muscle in a successive process revealed lower pole of the kidney. 3-4 approximation sutures between the lower pole capsule of the kidney and the fascia in the upper incision site, and transverse supporting suture of fat tissue below the lower pole of the kidney were done. Nephropexy by posterior vertical incision was performed in 8 cases(14 kidneys), including 6 cases of bilateral nephroptosis and 2 cases of unilateral nephroptosis. Compared with nephropexy by lumbar incision, nephropexy by posterior vertical incision has superiority, such as less operative incision, shorter operation time, minimal sensory and motor paralysis.