MP41-13 SURGICAL TECHNIQUE OF LAPAROSCOPIC NEPHROPEXY USING TVT(TENSION FREE VAGINAL TAPE) FOR PATIENTS WITH SYMPTOMATIC NEPHROPTOSIS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-13 SURGICAL TECHNIQUE OF LAPAROSCOPIC NEPHROPEXY USING TVT(TENSION FREE VAGINAL TAPE) FOR PATIENTS WITH SYMPTOMATIC NEPHROPTOSIS Ghazal Ameli*, Peter Weibl, Larissa Prüger, and Wilhelm Alexander Hübner Ghazal Ameli*Ghazal Ameli* More articles by this author , Peter WeiblPeter Weibl More articles by this author , Larissa PrügerLarissa Prüger More articles by this author , and Wilhelm Alexander HübnerWilhelm Alexander Hübner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephropexy has been under debate since its introduction to surgery. In fact, persistently arising flank pain and/or functional impairment in an upright position - verified in split renal function test - constitute an indication for intervention. In keeping with the previously by Huebner et al. published technique in 2004, we report on laparoscopic nephropexy using tension-free vaginal tape (TVT) for symptomatic nephroptosis. The aim of the study was to describe our surgical technique and report about a longer follow-up, as these surgeries were not embedded in a prospective study to begin with, there was also no academical protocol for the postoperative course. METHODS: From 3/2000 to 5/2019, 21 women (mean age 37.1 yr.) with symptomatic and radiographically proven (ultrasound and intravenous pyelogram) nephroptosis, were treated by laparoscopic nephropexy using a TVT tape.After standardized laparoscopic mobilization of the lower pole of the kidney, idendification of the ureter and renal pelvis, the needle of the TVT is directed below the lower pole of the kidney and pushed through the abdominal wall paravertebrally, just under the level of 12th rib. Afterward it is pushed through the abdominal wall again and guided over the lateral margins of the kidney. The sling is tightened until the kidney is fixed to the dorsal wall of the abdomen in a “loose fit” manner. No further fixation is needed. No postoperative drainage was placed. RESULTS: In all 21 cases the procedure was easily performed without any intraoperative complications. The mean operating time was 47.8 min. and the hospital stay after surgery was in average 4 days. Three patients required postoperative pain management according to Clavien-Dindo I, but there were no other complications. Postoperative intravenous pyelogram and ultrasound showed no recurrence in all cases after a mean follow up of 115.7 mts (range 2,8-227). 19 (90,5%) patients reported an improvement of symptoms, 2 (9,5%) complained about transient pain episodes 13 and 20 days, respectively. The visual analog score improved from 6.2 to 1.1. CONCLUSIONS: Using a tension-free vaginal tape for laparoscopic nephropexy is a safe and technically feasible procedure. In fact, prospective studies as well as good clinical results in a bigger cohort may be appreciated. However, leaving out the discussions about indications for nephropexy, we believe this simple technique is worth being presented to other urologists in order to broad the horizons of laparoscopic nephropexy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e599-e600 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli* More articles by this author Peter Weibl More articles by this author Larissa Prüger More articles by this author Wilhelm Alexander Hübner More articles by this author Expand All Advertisement PDF downloadLoading ...