Retroperitoneal laparoscopic nephropexy: Are there really indications for it?

Introduction: Nephropexy was never free of doubt despite good results noted in the literature. The reason for this was the high morbidity associated w ith this operation and indifferent complaints of the patient. Laparoscopy a nd retroperitoneoscopy now allow a minimally invasive form of therapy. Materials and Methods: Between August 1996 and December 1997, we performed this operation in 14 patients using a strictly retroperitoneoscopic approac h. Basic examination included an iv-pyelogram in a supine and upright posit ion and an isotopic nephrogram. Subjective symptoms such as pain and object ive symptoms such as pyelonephritis, urinary retention, hematuria, hyperten sion and reduced renal function were analyzed prior to surgery. Nephropexy was done after complete nephrolysis by fixation of the kidney to the psoas muscle. Results: Mean operation time was 96 minutes. Post-operatively, opiates were required for less than one day. After a mean follow-up of 12 months, 79% o f the patients were free of pain, the remaining 21% felt a significant reli ef of their complaints. None of the patients complained of objective symypt oms such as pyelonephritis, urinary retention or hematuria; Isotopic nephro gram performed post-operatively showed improvement of renal function and co ntrol-iv-pyelogram demonstrated no/or partial ptosis in 86% of the patients . Conclusion: Retroperitoneoscopy offers a minimally invasive, effective ther apy option in patients with symptomatic nephroptosis after correct definiti on of the indication.