Percutaneous nephropexy

Objective: The authors present a 12-year (1986-98) study of a new procedure called percutaneous nephropexy (PCNP). This procedure was performed on 51 renal ptosis patients at two urological departments tin Pakistan and Hungar y) with satisfactory results. The idea for PCNP was adapted from the observ ation that after drain insertion following nephrostomy a scar is quite suff icient to hold the kidney in place. That idea was used to fix the kidney at the required level. Material and Methods: Thirteen patients complained of a palpable mobile mass in the abdomen while others suffered from pain in th eir affected flank with recurrent attacks of urinary tract infection. On ul trasonic examination the kidney was found to be lower than the normal posit ion. This observation was confirmed by a standing intravenous urography (IV U) examination that also showed a tortuous ureter. Nine patients also had a stone in the affected kidney. The operation involved puncture and dilatati on of a channel through the lower calyx. Results: Control IVU examination w as performed after wound healing and was repeated 2 months after the operat ion, followed by consecutive ultrasonic examinations. Standing X-ray films obtained after contrast material injection showed the kidney to be at a hig her level with a straight ureter. Forty-five patients (88.2%) recovered com pletely. Conclusion: In the authors' opinion PCNP is a good alternative to open nephropexy operations in renal ptosis cases, particularly when laparos copic surgery facilities are not available. Although PCNP was developed in circumstances in which the availability of equipment was restricted, in ter ms of benefits it is comparable with laparoscopic nephropexy.