NEPHROPLICATION AND NEPHROPEXY AS AN ADJUNCT TO PRIMARY SURGERY IN THE MANAGEMENT OF GIANT HYDRONEPHROSIS

Objective To study the role of nephroplication and nephropexy as an ad junct to primary surgery in the management of giant hydronephrosis, wi th an aim to reduce stasis and improve drainage, thus preventing conse quent complications. Patients and methods Adjunctive nephroplication a nd nephropexy were performed in 20 renal units of 16 patients with gia nt hydronephrosis treated between January 1992 and March 1997, Twelve patients had unilateral and four had bilateral pelvi-ureteric junction obstruction, Four patients had elevated serum creatinine levels. All patients were treated with definitive surgery for the underlying disea se and an adjunctive nephroplication and nephropexy was performed at t he same time. Results Eighteen of the 20 renal units with giant hydron ephrosis showed an improvement in function and drainage as well as in pelvicalyceal system dilatation, while one remained unchanged and one deteriorated, None of the patients developed renal stones or pyeloneph ritis. Of the four patients with azotaemia, three showed definite impr ovement to normal levels while one stabilized. Conclusions Nephroplica tion and nephropexy of giant hydronephrotic kidneys are useful adjunct ive procedures to reduce pelvicalyceal system stasis and to improve dr ainage, thereby preventing subsequent stone formation, infection and d eterioration in renal function.