Plas E, Daha K, Riedl C R, Hübner W A, Pflüger H
Department of Urology, LBI for Urology and Andrology, Lainz Hospital Vienna, Vienna, Austria.
J Urol. 2001 Aug;166(2):449-52.
Symptomatic nephroptosis is a rare disease requiring surgical therapy only in select cases. Laparoscopic nephropexy has been reported as minimally invasive treatment for symptomatic patients. We evaluated our long-term outcome after laparoscopic fixation of the kidney with an alloplastic mesh graft.
Since 1992, 30 patients have undergone laparoscopic transperitoneal nephropexy for symptomatic nephroptosis. All patients were preoperatively investigated by excretory urography (IVP) and split renal scan in the supine and upright positions. For fixing the kidney to the abdominal wall a polyglactin and polypropylene mesh graft was used in 6 and 24 cases, respectively. A total of 17 patients with a minimum followup of 5 years participated in an assessment of long-term outcome. Clinical examination, IVP and split renal function testing were performed with patients lying and standing. Patients were further questioned about postoperative satisfaction and whether they would undergo the procedure again.
Of 17 patients 10 completed all investigations, 3 were contacted by telephone and 4 were lost to followup. Median followup was 5.9 years. Improvement in symptoms was reported in all cases with complete relief in 11 and intermittent flank pain requiring no medication in 2. There were no postoperative urinary tract infections or hematuria observed with improved hypertension requiring no postoperative medication in 1 case. Postoperatively IVP showed no recurrence in 8 of 10 patients but there was 5 cm. or greater recurrent ptosis in 2. Recurrence developed after using the polyglactin and polypropylene mesh grafts. Comparing preoperative and postoperative (123)iodine renal scans revealed significant improvement in renal function in 9 cases (p <0.05). There was no postoperative difference in split renal function and only 1 patient did not improve. No complications were noted except 1 symptomatic recurrence 3 months after the initial operation that required open surgical fixation. A total of 11 patients were completely satisfied with the long-term outcome and 2 were moderately satisfied. Of the patients 12 would undergo the procedure again, including 2 with persistent slight flank pain. One patient was inconsistent in regard to whether she would undergo the procedure again.
Symptomatic nephroptosis is a bothersome disease requiring therapy only after thorough evaluation, including IVP and split renal scan with patients supine and upright. The good clinical outcome and highly satisfactory cosmetic result support laparoscopic nephropexy as the treatment of choice. Short-term and long-term results prove the efficacy of renal fixation with alloplastic mesh graft as minimally invasive therapy with a high success rate.
症状性肾下垂是一种罕见疾病，仅在特定病例中需要手术治疗。腹腔镜肾固定术已被报道为有症状患者的微创治疗方法。我们评估了使用同种异体网片移植进行腹腔镜肾脏固定术后的长期疗效。
自1992年以来，30例患者因症状性肾下垂接受了腹腔镜经腹肾固定术。所有患者术前均通过排泄性尿路造影（IVP）以及仰卧位和直立位的分肾功能扫描进行评估。分别在6例和24例患者中使用聚乙醇酸和聚丙烯网片移植将肾脏固定于腹壁。共有17例患者参与了长期疗效评估，其随访时间最短为5年。对患者进行卧位和站立位的临床检查、IVP及分肾功能测试。进一步询问患者术后满意度以及是否愿意再次接受该手术。
17例患者中，10例完成了所有检查，3例通过电话联系，4例失访。中位随访时间为5.9年。所有病例症状均有改善，11例完全缓解，2例间歇性胁腹疼痛无需药物治疗。未观察到术后尿路感染或血尿，1例患者高血压改善且术后无需药物治疗。术后IVP显示，10例患者中有8例无复发，但2例有5厘米或更大程度的复发性肾下垂。复发出现在使用聚乙醇酸和聚丙烯网片移植后。比较术前和术后的（123）碘肾扫描显示，9例患者肾功能有显著改善（p<0.05）。分肾功能术后无差异，仅1例患者未改善。除1例初始手术后3个月出现有症状复发需行开放手术固定外，未发现其他并发症。共有11例患者对长期疗效完全满意，2例中度满意。12例患者愿意再次接受该手术，包括2例仍有轻微胁腹疼痛的患者。1例患者对于是否愿意再次接受该手术态度不一。
症状性肾下垂是一种令人困扰的疾病，仅在经过包括IVP以及患者仰卧位和直立位的分肾功能扫描等全面评估后才需要治疗。良好的临床疗效和高度满意的美容效果支持腹腔镜肾固定术作为首选治疗方法。短期和长期结果证明，同种异体网片移植肾脏固定术作为微创治疗方法具有很高的成功率和疗效。
