TITLE:
Clinical Experience in the Treatment of Nephroptosis Using Retroperitoneal Laparoscopic Nephropexy
AUTHORS:
Ruojing Wei
KEYWORDS:
Nephroptosis, Retroperitoneoscopic, Nephropexy
JOURNAL NAME:
Open Journal of Urology,
Vol.4 No.6,
June
17,
2014
ABSTRACT:
Background:
Retroperitoneal laparoscopic nephropexy has been applied to nephroptosis. We
investigate the approach and treatment effect of retroperitoneal laparoscopic
nephropexy. Methods:From May 1990 to October 2013, 45 patients with
nephroptosis treated in our hospital were retrospectively analyzed. Among them,
25 patients underwent nephropexy (open surgery group), the other 20 patients
underwentretroperitoneal laparoscopic nephropexy (laparoscopic surgery
group). In open surgery group,there were 24 females and 1 male, aged 20 -
35 years. In laparoscopic surgery group, there were 19 females and 1 male, aged
20 - 35 years.All of them withnephroptosis of the right kidney were
combined with lower back pain or hematuria and underwent intravenous
pyelography (IVP) and colorultrasoundinorthostatic and supine
position for a specific diagnosis. In open surgery group, patients underwent
open surgery. Their kidneys werefully dissociated,then, the upper
andmiddle pole of the dorsal kidney
wassuturedwithlumbar fasciafor two stitches for
fixation respectively. While inlaparoscopic surgery group,kidneys
were fully dissociated in Gerota’s fascia during laparoscopic surgery,
andthe upper pole of the dorsal kidney was suturedwith
thelumbar fascia fortwostitches using a2-0 absorbable
suture. They were all in the supine position for a week after
surgery.Thebody mass index (BMI), operation time, bleedingamount,postoperative
hospital stay,wound complication rate and other indicators were compared
between two groups. Results:BMI in open surgery group was 16.77 ± 0.80
kg/m2, BMI inlaparoscopic surgery group was 16.73 ± 0.78 kg/m2, P >
0.05 showed no statistical difference; the operation time in open surgery group
was 70.96 ± 10.61 min, that in laparoscopic surgery group was 34.65 ± 4.87
min, PP P >
0.05 showed no statistical difference. In open surgery group, four patients
hadwound infection which delayed the healing, and the wound complication
rate was 16% (4/25). In laparoscopic surgery group,wound complications
did not appear, the incidence was 0%, X2 = 1.8144, P >
0.05 showed no statistical difference. The mean follow-up visit lasted 1.5
years after surgery (3 months to 2 years), B-mode ultrasound in orthostatic and
supine position showed kidneys were in the normal position. Compared with those
before surgery, postoperative uncomfortable symptoms completely disappeared in
all patients. Conclusions: Retroperitoneal laparoscopic nephropexy has a good
effect onsymptomaticnephroptosis. The two stitchesof suture
between the upper pole of the dorsal kidney and the lumbar fascia
showconvenient operation, less damage andfaster postoperative
recovery, which are better than open surgery.