Retroperitoneal laparoscopic nephropexy

Despite good results, the topic of nephropexy was never free of discussions , in part due to the extensive trauma of the procedure accompanied by a fre quently indifferent array of patient complaints. This is where laparoscopy and retroperitoneoscopy allow for a minimally invasive approach in therapy. Between August 1996 and December 1999, 31 patients underwent retroperitone oscopic nephropexies. Besides an intravenous pyelogram (IVP) in supine and upright position as well as renal function tests, the presurgical assessmen t included the analysis of subjective (pain) and objective (pyelonephritis, upper tract obstruction, hematuria, hypertension) symptoms. Nephropexy was performed by complete nephrolysis and fixation of the kidney to the psoas muscle. The mean surgery time was 103 minutes, the need for pest-surgical o piates was less than 1 day. Following an average follow-up period of 24 mon ths, 83% of the patients were pain free and an additional 17% reported a si gnificant relief of their complaints. All of the patients were free of obje ctive symptoms such as pyelonephritis, upper tract obstruction, or hematuri a. In 13 of the 14 post-surgically performed isotopic renograms, an improve ment in renal function could be documented. The postoperative NP revealed n o ptosis or ptosis incorporating no more than one vertebral body in 87% of the patients. In cases in which the indications for nephropexy are clearly defined, retroperitoneoscopy offers an effective minimally invasive therapy of symptomatic nephroptosis.