The Curative Effect Of Laparascopic Nephropexy For Symptomatic Nephroptosis

Nephroptosis is defined as a significant downward displacement of the kidney for >5cm when the body posture is changed from a supine to an erect position.The typical symptom of the nephroptosis is dragging pain or soreness in the flank,especially after long periods in an upright position,the pain is relieved by recumbency.Some of the patients accompany with renal calculus,hypertension,recurrent urinary tract infection,hematuria,or deprssion,the serious symptom is Dietl's crisis.Only few nephroptosis need surgical treatment.Hahn described the first nephropexy in 1881,since then,morn than 170 operative techniques have been proposed.But the long flank incision,significant postoperative morbidity,and an rnsatisfactory failure rate limited the use of open nephropexy an made the choice of surgical treatment for nephroptosis controversial an a subject of extensive dispute.In 1992,Urban finished the first laparoscopic nephropexy of the world.Since then,various techniques of laparoscopic nephropexy were reported.From January 2001 tofebruary 2007,17 nephroptosis patients underwent laparoscopic nephropexy in our hospital,herein wo describe the technique and curative effect of our method of laparoscopie nephropexy.Materials and Methods1. Common MaterialsFrom January 2001 to february 2007,17 nephroptosis patients underwent laparoscopic nephropexy in our hospital,2 men, 15 women. 15 were just affacted the right kidney,and the other two were bilateral .Aged from 33 to 65 years old(median age 47.1 years old).The mean body mass index was 19.1 kg/m~2 (range 17.3-21.8).A11 of the patients had the typical dragging pain or soreness in the flank,especially after long periods in an upright position,the pain is relieved by recumbency,three of them accompany with renal calculus,four of them had recurrent urinary tract infection,seven of them with hydronephrosis.All of the patients were examined IVP,showed the kidney was decent >5cm when the body changed from a supine to an erect position,and they are evaluated before operation.2. Operation MethodsThe patients accompany with renal calculus underwentlaparoscopic excision of renal calculus,two bilateral nephroptosis were done laparoscopic nephropexy at the same,the other 15 patients were just done laparoscopic right nephropexy.The operations uesd unabsorption Polypropylene net to fix the kidney to psoas.ResultsThe operation was successful in all patients .Mean operative time was 121.9 min (range 75-210 min).The mean estimated intraoperative blood loss was 45 ml (range 20-100 ml).There were mo major or minor intraoperative complications.Two patients got fever after operation.Postoperative narcotic use averaged 40 mg.Patients began oral intake after 18 hours (range 5-36 h).The average postoperative hospital stay was 7.6 d (range 5～9 d).All of the patients felt the flank pain relieved three days after. Postoperative folllow-up range from 2 months to 5.1 years,the patients all went back to work in one month. 15 patients felt the flank pain were completely relieved,the other two still had pain ,but much better than preoperation.10 patients reexamine IVP postoperation,showed the kidney was decent < 5cm when the body changed from a supine to an erect position.No renal calculusrecurrence,hydronephrosis was improved.ConclusionFew nephroptosis patient need surgical treatment,before laparoscopic nephropexy,patients must be completely evaluated.Laparoscopic nephropexy is a minimally invasive,feasible and highly successful option for treating patients with symptomatic nephroptosis.