Laparoscopic Nephropexy Research Articles

ОПРЕДЕЛЕНИЕ ХИРУРГИЧЕСКОЙ ТАКТИКИ У ПАЦИЕНТОВ С НЕФРОПТОЗОМ НА ОСНОВАНИИ ПРОТИВОПОКАЗАНИЙ К ЛАПАРОСКОПИЧЕСКОЙ НЕФРОПЕКСИИ

Introduction. The study of the literature indicates that the list of indications for laparoscopic nephropexy (LNP) in patients with nephroptosis meets the requirements of urological practice, but contraindications to this operation do not correspond. Aim of the research. Based on the modern approach to determining contraindications for LNP, to develop a rational treatment strategy for performing this operation in patients with nephroptosis, aimed at reducing the frequency and severity of complications. Materials and methods. The study included the results of examination and treatment of 208 patients with stage 2–3 nephroptosis. In 1987–2001 103 patients (control group) underwent nephropexy according to the Pytel-Lopatkin method, taking into account the contraindications to nephropexy existing at that time. In 2002–2012 62 patients (main group A) underwent LNP using a polypropylene mesh according to our patented method. At the same time, LNP was contraindicated in 43 outpatients (main group B), taking into account the author's list of contraindications. Results. The use of the author's list of contraindications made it possible to establish among the patients of the main group B absolute contraindications to LNP in 9.3%, relative – in 37.2%, temporary – in 44.2%, special contraindication to LNP – in 4 (9.3%), which contributed to the prevention of possible postoperative complications among them, and among patients of the main group A, compared with the control group, there was a statistically significant reduction in postoperative complications. Conclusion. Therapeutic tactics based on the author's list of contraindications is that the patients with absolute contraindications to LNP are recommended conservative treatment; with relative contraindications – when transferring the concomitant diseases from subcompensation to compensation and with temporary contraindications – in the treatment of these diseases, LNP is performed. And in patients with special contraindication to LNP (abdominal adhesive disease), open nephropexy is performed. A new list of contraindications to LNP in patients with nephroptosis can be recommended for wider implementation in urological practice, which may contribute to improving the quality of treatment of these patients.

V06 - Laparoscopic nephropexy – an innovative approach to correct incomplete renal rotation and ureteropelvic junction syndrome

V06 - Laparoscopic nephropexy – an innovative approach to correct incomplete renal rotation and ureteropelvic junction syndrome

Laparoscopic Nephropexy: The Sliding Clip Technique.

Background: Nephroptosis is a clinical condition characterized by symptoms related to an abnormal caudal movement of the kidney. During the past decade, the availability of laparoscopic surgery has led to a revival of interest in nephroptosis. Most of the traditional surgical techniques aim to achieve kidney fixation by placing triangulation sutures between the abdominal wall and the renal capsule. These sutures are often difficult to tie because of the confined working space. Case Presentation: We herein present a case of a 31-year-old female patient who presented with symptomatic right-sided nephroptosis and was managed effectively by laparoscopic nephropexy. We have applied a technical modification to facilitate laparoscopic fixation by utilizing suture and nonabsorbable polymer clips ("sliding clip" technique). Conclusion: Laparoscopic nephropexy is a safe and effective procedure for the management of symptomatic nephroptosis. The "sliding clip" technique is a modification familiar to most urologists that facilitates intracorporeal suturing and adequate renal fixation.

438 - Surgical technique of laparoscopic nephropexy using TVT (Tension free Vaginal Tape) for patients with symptomatic nephroptosis

438 - Surgical technique of laparoscopic nephropexy using TVT (Tension free Vaginal Tape) for patients with symptomatic nephroptosis

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

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 ...

Curative effect evaluation of retroperitoneal laparoscopic and open polypropylene mesh belt nephropexy

Objective To compare effect of retroperitoneal laparoscopic and open polypropylene mesh belt nephropexy in the treatment of nephroptosis. Methods Between April 2008 and December 2017, 64 patients with renal prolapse in our hospital were divided into control group and observation group according to surgical method, 32 cases in each group. The patients in the control group underwent open polypropylene mesh belt after 12 ribs kidney suspension, the observation group was given laparoscopic polypropylene mesh belt nephropexy treatment.Recurrence rate, complication, operation time, blood loss, postoperative analgesia, bed time, length of hospital stay, the quality of life of two groups were observed. Results The average operation time, bed time, length of hospital stay of the observation group were significantly shorter than the control group, blood loss was significantly less than the control group, the number of postoperative analgesia was significantly less than the control group (P 0.05). After different treatment, Two groups got significant improvement in the patient's quality of life, each index score was significantly improved, and the observation group had better quality of life after treatment (P<0.05). Conclusions Compared with the open polypropylene by 12 ribs for the treatment of kidney suspension, the curative effect of retroperitoneal? laparoscopic polypropylene mesh belt nephropexy is better. Key words: Kidney Diseases; Laparoscopy; Tissue Fixation; Polypropylenes

Clinical reappraisal and state of the art of nephropexy.

The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.

VE38 - Robotic assisted laparoscopic nephropexy in a 28 year old woman with a floating kidney; A diagnosis often questioned

VE38 - Robotic assisted laparoscopic nephropexy in a 28 year old woman with a floating kidney; A diagnosis often questioned

Laparoscopic nephropexy: Treatment outcome and quality of life

INTRODUCTION : Surgical treatment of nephroptosis is rarely performed nowаdays and is done only in symptomatic patients. Here we present the results of our laparoscopic nephropexy in patients with symp­tomatic nephroptosis. MATERIALS AND METHODS : For a period from March 2014 to March 2015, a total of 8 women at an av­erage age of 54 years were operated on in our clinic . Four of the patients were with nephroptosis of the left kidney, three of the right one and one had bilateral nephroptosis. Most of the patients complained of pain and discomfort in active movement, only one individual had complaints consisting of intermittent macro­scopic hematuria. One patient had been operated on in the past by a classic open method of the same kidney. Preoperatively, for all patients, intravenous urography in supine and standing position was performed. All patients were operated on trans-peritoneally through 3 ports: 1x10 mm and 2x5 mm. The kidney was com­pletely mobilized and kidney fat was dissected. The upper and middle pole of the kidney were fixed to mus­culus psoas major, using a single non-absorbable suture and intracorporeal technique for tying. RESULT : All operations were performed with minimal blood loss, an average operating time of 45 minutes and a hospital stay of 4 days. No conversion was required in any of the cases. Postoperatively, patients were tracked and monitored by ultrasound examination. At 3 months we did IVP, which showed the correct loca­tion of the kidney. All patients remained asymptomatic for an average of 11 months after surgery. CONCLUSION : Laparoscopic transperitoneal nephropexy is a safe and effective procedure and a promising method for correction of symptomatic nephroptosis.

AB186. Laparoscopic nephropexy using a self-designed polytetrafluoroethylene “basket”

ObjectivesLaparoscopic nephropexy has been reported as a minimally invasive approach for symptomatic nephroptosis. We performed five cases of laparoscopic nephropexy using a self-made polytetrafluoroethylene “basket” to fix the inferior parts of kidneys to 12th rib.MethodsAll patients (four women and one man) had symptomatic nephroptosis presenting with flank pain, repeat hemoturine or hydronephrosis. Preoperative ultrasonography, intravenous urography and renal CT scan in supine and upright positions were done for nephroptosis diagnosis. Transperitoneal laparoscopic nephropexy were carried out using self-prepared “basket” made of stripes cutting from polytetrafluoroethylene herniorrhaphy mesh. After the kidney was completely dissected from surrounding perirenal fat, it was put into the non-absorbable polytetrafluoroethylene “basket” through multiple suturing and fixation to renal capsule. Then suspended the kidney by fixation the lower pole of kidney to the twelfth rib, and reinforced by suturing the posterior surface of the kidney to the quadratus lumborum muscle.ResultsThe operation was successfully completed laparoscopically in all cases without major perioperative complications. The average operative time was 95 minutes, and the mean estimated blood loss was less than 60 mL. Hospital stay was 4.5 days (range, 3–6 days). Postoperative urography or ultrasound revealed complete resolution of loin pain and nephroptosis with a median follow-up of 8 months (range, 2–15 months).ConclusionsLaparoscopic nephropexy using self-made polytetrafluoroethylene “basket” with a modified three-point fixation technique is an effective minimally invasive procedure for treating symptomatic nephroptosis with excellent short-term results.

Comparison of surgical intervention and non-surgery result in early prostate cancer

s / Urological Science 26 (2015) S50eS81 S57 The operation began with 7ecm midline incision above the umbilicus. A small hole of cystic wall was created and more than 6 L of yellowish clear fluid was drained. The hand-assisted device was placed in midline wound. While other two 10-mm trocar were placed in left lower abdomen and left anterior axillary line subcostally. The membrane of cyst was dissected as much as possible. Nephropexy was done to attach migrating left kidney to the back of the abdominal wall. The postoperative course was uneventful and the patient was discharged 3 days after the operation. Intravenous urography done 3 months later showed normal kidney position and bilateral patent ureters. Discussion: A huge renal cyst measuring more than 15 cm is an extremely rare. Cases presenting simply with progressive abdominal distention can lead to misdiagnosis, such as obesity or ascites. In our case, huge left renal cyst caused left kidney migration to right side, leading to initial misdiagnosis of right acute pyelonephritis. Surgery has been considered the mainstay of treatment for giant cyst. We performed hand assisted laparoscopic renal cyst unroofing and nephropexy with uneventful postoperative course and good outcome. NDP028: UNUSUAL URETHRAL FOREIGN BODIES Wei-Chung Hsiao , Sung-Lang Chen , Yu-Lin Kao , Wen-Jung Chen , Tzuo-Yi Hsieh , Shao-Chuan Wang . Division of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Purpose: Urethral foreign bodies are uncommon clinical conditions. Most of the foreign bodies are self-introduced under the circumstances of autoerotic impulses, sexual curiosity, psychiatric illness, or rarely migration from adjacent organs. Retrieval of the urethral foreign body is casespecific due to wide variety of foreign bodies. Materials and Methods: A 75-year-old man was sent to emergency department after a motorcycle accident. Serial examinations including pelvic radiography and computed tomography discovered 5 fishhooks within the urethra unexpectedly. Ingrowth into urethral mucosa of the fishhooks with related inflammatory process was noted. Due to complexity of the fishhook position and pelvic fracture condition, cystourethroscopic retrieval of the foreign bodies was performed successfully in a two-step manner. Results: Self-inflicted urethral foreign bodies have a very low incidence. Major complications of urethral foreign bodies include trauma, infection, urine retention, and urethral stricture. Most of the foreign bodies of lower urinary tract can be treated with endourological modalities. The key point of urethral foreign body extraction relies on its physical attributes and morphology with the purpose of minimal urothelial injury. Conclusion: The urethral foreign bodies could be removed successfully by cystourethroscopic procedure without any complication, even in the presentation of mucosal ingrowth.

Clinical Experience in the Treatment of Nephroptosis Using Retroperitoneal Laparoscopic Nephropexy

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 underwent retroperitoneal 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 with nephroptosis of the right kidney were combined with lower back pain or hematuria and underwent intravenous pyelography (IVP) and color ultrasound in orthostatic and supine position for a specific diagnosis. In open surgery group, patients underwent open surgery. Their kidneys were fully dissociated, then, the upper and middle pole of the dorsal kidney was sutured with lumbar fascia for two stitches for fixation respectively. While in laparoscopic surgery group, kidneys were fully dissociated in Gerota’s fascia during laparoscopic surgery, and the upper pole of the dorsal kidney was sutured with the lumbar fascia for two stitches using a 2-0 absorbable suture. They were all in the supine position for a week after surgery. The body mass index (BMI), operation time, bleeding amount, 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 in laparoscopic 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, P P P > 0.05 showed no statistical difference. In open surgery group, four patients had wound 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 on symptomatic nephroptosis. The two stitches of suture between the upper pole of the dorsal kidney and the lumbar fascia show convenient operation, less damage and faster postoperative recovery, which are better than open surgery.

Laparoscopic Nephropexy with Polymer Clips

We present our initial experience and long-term results with transperitoneal laparoscopic nephropexy with nonabsorbable polymer clips. Seven patients aged 34 to 47 years previously diagnosed with mobile kidney presented with chronic pain refractory to analgesics and underwent a transperitoneal laparoscopic nephropexy procedure with nonabsorbable polymer clips by fixing the perirenal tissue to the transversus abdominis fascia and triangular ligament. Mean operation time was 20 minutes. All patients were discharged after 24 hours. Follow-up intravenous pyelogram (IVP) at 60 and 150 days showed the right kidneys in a more cephalad position, and showed pelvicaliceal dilatations and that the ureteral kinks seemed to be resolved. On days 15, 60, 90, and 150 of the first- and second-year follow-ups, severity of pain was 1 of 10 on the visual analog scale. We believe that the technique of transperitoneal laparascopic nephropexy with nonabsorbable polymer clips on patients with symptomatic mobile kidney is safe and easy to perform and shows successful long-term results.

Pediatric robotic assisted laparoscopic nephropexy: case study

We describe pediatric robotic assisted laparoscopic left nephropexy in a 12-year-old female for symptomatic nephroptosis after partial nephroureterectomy.

Application of "cinch/tie" technique to robotic-assisted nephropexy for posterior abdominal wall fixation.

Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a "figure of eight" fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46years (43-52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2months (1-28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several "pexing" sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.

Laparoendoscopic Single-Site Nephropexy with Homemade Single Port

Introduction: Laparoscopic nephropexy is a safe and effective procedure for symptomatic floating kidney. The posterior retroperitoneoscopic approach is thought to be the most promising method for single-access surgery of the floating kidney. Here, we report our preliminary experiences in laparoendoscopic single-site surgery (LESS) retroperitoneal nephropexy with homemade single port for symptomatic floating kidneys. Materials and Methods: LESS retroperitoneal nephropexy was performed with a homemade single port that was created using an Alexis wound retractor as an access platform through a 2-cm incision beneath the tip of 12th rib.1 This video included a brief presentation of a case of a 65-year-old woman who presented with recurrent urinary tract infection and intermittent right flank soreness when activity. She was a slim woman with a body mass index of 21. The flank soreness was usually exacerbated by an upright position and relived by recumbence. Then, supine and erect intravenous pyelography was performed and it revealed downward displacement of two vertebral bodies of right kidney on erect position. The procedure was completed successfully without conversion. The operative time was 110 min. Results and Conclusions: Between May 2009 and July 2010, we had performed LESS nephropexy for four consecutive patients with symptomatic floating kidneys (bilateral in 1 and right in 3). The mean patient age was 44.6±17.7 years and mean body mass index was 21.4 kg/m2. The mean operative time was 121.0±29.7 min. Mean estimated blood loss was minimal, and mean hospital stay was 3.3±0.5 days. Conversion to an open or conventional retroperitoneoscopic approach was not necessary in all cases. There was no major complication. Follow-up intravenous pyelography study 3 months after procedure revealed that the treated kidneys were in the desired position and axis with a standing descend less than one vertebral body in all patients. In conclusion, LESS retroperitoneal nephropexy with homemade single port is a safe and feasible procedure for symptomatic floating kidneys. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits of LESS nephropexy. All authors have declared no conflicts of interest. Runtime of video: 7 mins 1 sec Shih-Dong Chung and Victor Chia-Hsiang Lin contributed equally to this work.

Laparoscopic nephropexy in a case with nephroptosis

Laparoscopic nephropexy in a case with nephroptosis

Laparoscopic nephropexy exposes a possible underlying pathogenic mechanism and allows successful treatment with tissue gluing of the kidney and fixation of the colon to the lateral abdominal wall

Surgical treatment of "Ren Mobilis" has historically been associated with poor results and fairly high morbidity. We have used a transperitoneal laparoscopic approach in order to minimize morbidity. The goal of this study was to evaluate the success rate and to discuss the possible pathogenic mechanism, which has implications for the surgical strategy. Seven women with a right mobile kidney were examined by intravenous pyelogram and CT scans. Symptoms were judged to emanate from the mobile kidney. Transperitoneal laparoscopic nephropexy was performed. The surgical treatment consisted of fixing the kidney to the dorsal abdominal wall using tissue glue (Tisseel) after diathermy coagulation of the surfaces to induce fibrosis. The right colon was fixed with clips to the lateral abdominal wall, trapping the kidney in place. In 6 of the cases, there was an incomplete rotation of the ascending colon to the right side, allowing the kidney to move freely. In one case, the kidney moved into a retroperitoneal pocket of the mesocolon. The 6 cases with a lateral passage for the kidney were symptom-free at follow-up (30-80 months), but in the 7th case the patient's kidney quickly loosened and she underwent an open reoperation, after which she was symptom-free. Our series demonstrates that good results can be achieved with a transperitoneal laparoscopic approach, but also indicates that there is a common pathogenic mechanism with incomplete rotation of the ascending colon that can be corrected during surgery, which might contribute to the good results.

The Latest Technique for Laparoscopic Nephropexy Using Cyanoacrylic Glue

Aim: To evaluate the use of cyanoacrylic glue to fix the kidney in laparoscopic nephropexy for symptomatic nephroptosis. Patients and Methods: From 1998 to 2006 we performed nephropexy in 10 women with symptomatic nephroptosis. In all patients we performed transperitoneal laparoscopic nephropexy using cyanoacrylic glue to fix the kidney. Preoperatively all patients were investigated by clinical exami-nation, urography (intravenous pyelogram, IVP) and split renal scintigram in supine and upright positions. After a minimum follow-up of 30 months, all patients were evalu-ated for symptoms, were asked about their satisfaction and underwent IVP and renal scintigraphy. Results: The mean operative time was 53 minutes. No intra- or post-operative complication occurred. The mean hospital stay was 4.5 days. After a mean follow-up of 88 months, improvement in symp-toms was reported in all cases, with complete and significant relief in 9 (90%) and 1 (10%) case respectively. Postoperative IVP and renal scintigraphy in supine and upright positions showed the resolution of renal ptosis and the normal distri-bution of split renal function in both positions. Conclusions: Our series seems to demonstrate that cyanoacrylic glue may be a safe and efficient agent to fix the kidney in laparoscopic nephropexy.

Laparoscopic Nephropexy

We evaluated the safety and efficacy of laparoscopic nephropexy for symptomatic nephrotosis. Between May 2000 and December 2005, 6 women (mean age, 43.1 years) underwent laparoscopic nephropexy of 8 kidneys (6 right, 2 left). Mean body mass index was 19.6 kg/m(2). Two patients displayed ureteropelvic junction obstruction (UPJO). Preoperative evaluation was performed by intravenous urography (IVU) and isotope renography in both the supine and erect positions. Four patients (6 renal units) underwent retroperitoneoscopic nephropexy, with a dismembered pyeloplasty in 1 patient (1 renal unit). The transperitoneal approach was performed in 2 patients, the first case and another with UPJO due to an aberrant vessel. The kidney was mobilized, then fixed to the back muscles with nonabsorbable sutures. Mean operative time was 139.4 minutes (range, 95-200), and mean blood loss was 30 mL (range, 10-60). No perioperative complications were encountered. Mean hospital stay was 6.4 days. Postoperative IVU and isotope renography correctly confirmed a fixed kidney and no obstruction in the UPJO cases. All patients reported a symptomatic improvement during follow-up (range, 11-81 months). As pain is the presenting symptom in these cases, a laparoscopic approach seems to represent the gold standard for treatment owing to low morbidity and good cosmetic results.