Moss S W
Department of Medicine, St. Peter's Medical Center, New Brunswick, New Jersey, USA.
J Urol. 1997 Sep;158(3 Pt 1):699-702.
Recently trained physicians are often unfamiliar with nephroptosis. Nephropexy, once a routine operation, almost disappeared from American practice more than 2 decades ago. In view of a recent revival of interest in nephroptosis and nephropexy in the American urological literature, a historical overview of nephroptosis and the evolution of surgical nephropexy is timely.
A National Library of Medicine data base (1966 to 1996) search of "nephroptosis," "nephropexy" and "Dietl's crisis" was performed. Textbooks and monographs from the last 100 years were consulted. Original clinical descriptions and surgical accounts dating back more than 130 years were traced and reviewed.
Nephroptosis and nephropexy have been subjects of controversy since Edebohls in New York popularized nephropexy in 1893. A close association with "neurasthenia" clouded objectivity prior to 1920. Nearly 200 surgical procedures were described. Urological opinion was often sharply polarized. In the last 2 to 3 decades the subject was largely eclipsed in the United States. Recently, however, new laparoscopic surgical techniques have been applied to the treatment of symptomatic nephroptosis.
Few diagnoses and surgical procedures have had such a contentious and colorful history. It seems likely that new criteria for diagnosis of symptomatic nephroptosis and the introduction of laparoscopic nephropexy will lead to renewed interest in the subject among generalists and specialists. Knowledge of the current literature can be enriched by an overview of the events of the last century.
刚培训出来的医生往往对肾下垂并不熟悉。肾固定术曾是一种常规手术，20多年前在美国的临床实践中几乎消失。鉴于最近美国泌尿学文献中对肾下垂和肾固定术的兴趣再度兴起，适时地对肾下垂及外科肾固定术的演变进行一次历史回顾很有必要。
利用美国国立医学图书馆数据库（1966年至1996年）检索“肾下垂”“肾固定术”及“Dietl危象”。查阅了过去100年的教科书和专著。追溯并回顾了130多年前的原始临床描述和外科手术记录。
自1893年纽约的埃德博尔斯推广肾固定术以来，肾下垂和肾固定术一直是争议的话题。在1920年之前，与“神经衰弱”的密切关联影响了客观性。共描述了近200种外科手术。泌尿学界的观点常常两极分化。在过去二三十年里，这个话题在美国基本上不再受关注。然而，最近新的腹腔镜手术技术已被应用于有症状肾下垂的治疗。
很少有诊断方法和外科手术有着如此充满争议和丰富多彩的历史。有症状肾下垂的新诊断标准以及腹腔镜肾固定术的引入，似乎可能会使全科医生和专科医生重新对该话题产生兴趣。回顾上世纪的相关事件可以丰富对当前文献的了解。
