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Percutaneous endoscopic nephropexy with a percutaneous suture passed through the kidney

View Article: PubMed Central

ABSTRACT

Objectives: To report a technique of percutaneous endoscopic nephropexy, using a polyglactin suture passed through the kidney, in patients with nephroptosis.

Patients and methods: Four women presenting with symptomatic right nephroptosis underwent a percutaneous endoscopic nephropexy. An upper-pole calyx was accessed percutaneously and a 24-F working sheath was placed. Another needle access was made through a lower-pole calyx and a #2 polyglactin suture was passed into the renal pelvis. It was then pulled out through the upper-pole tract using the nephroscope. A retroperitoneoscopy was performed and the tip of the nephroscope was used to cause nephrolysis. After inserting the nephrostomy tube the polyglactin suture was passed into the subcutaneous tissue and then tied without too much tension, to avoid cutting the parenchyma.

Results: The operative duration was 33 min and the hospital stay after surgery was 3.5 days. The nephrostomy catheter was removed 5 days after surgery. There were no complications, especially no haemorrhagic, infectious, lithiasic or thoracic complications. The four patients were relieved of their initial symptoms, with a mean follow-up of 28 months. Ultrasonography and/or intravenous urography showed the kidney at a higher location with the patient standing.

Conclusions: This technique combines the nephrostomy tract used in percutaneous techniques with the suture and nephrolysis used in laparoscopic techniques. Moreover, this procedure seems to be safe, with satisfactory anatomical and clinical results and a lower morbidity. However, a larger series will be necessary to establish its long-term morbidity and success rate.

No MeSH data available.


(A) IVU before surgery, with the patient upright, shows descent and tilting of the right kidney, with a kink in the proximal ureter. (B) IVU at 40 months after surgery, with the patient upright, shows the right kidney in a higher position.
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f0030: (A) IVU before surgery, with the patient upright, shows descent and tilting of the right kidney, with a kink in the proximal ureter. (B) IVU at 40 months after surgery, with the patient upright, shows the right kidney in a higher position.

Mentions: Percutaneous nephropexy was technically possible in all four patients, and the mean (range) operative duration was 33 (28–37) min. Analgesic intravenous paracetamol was used on the first day after surgery, and no further analgesic therapy was needed. To allow initial scarring and fixation of the kidney, the patients were advised to stay in bed in the dorsal position for 2 days. Mechanical methods of thromboprophylaxis (anti-embolism stockings, leg movements), and low-molecular-weight heparin, were used to prevent thromboembolic complications. One patient had a mild fever (38.7 °C) on the first day, but that resolved spontaneously. Although there was a retroperitoneal dissection there was no large extravasation, nor any other complication, especially haemorrhagic, infectious or thoracic. The patients had an uneventful discharge and the mean (range) hospital stay after surgery was 3.5 (2–5) days. The nephrostomy catheter was removed 5 days after taking the nephrostogram. There were no late complications secondary to the suture into the calyceal system, and no haemorrhage, infection or stone formation. The patients reported a subjective resolution of their initial symptoms. Ultrasonography and/or IVU showed the kidney at a higher position, with the patient erect, than before surgery (Fig. 6), with a mean (range) follow-up of 28 (7–60) months.


Percutaneous endoscopic nephropexy with a percutaneous suture passed through the kidney
(A) IVU before surgery, with the patient upright, shows descent and tilting of the right kidney, with a kink in the proximal ureter. (B) IVU at 40 months after surgery, with the patient upright, shows the right kidney in a higher position.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442924&req=5

f0030: (A) IVU before surgery, with the patient upright, shows descent and tilting of the right kidney, with a kink in the proximal ureter. (B) IVU at 40 months after surgery, with the patient upright, shows the right kidney in a higher position.
Mentions: Percutaneous nephropexy was technically possible in all four patients, and the mean (range) operative duration was 33 (28–37) min. Analgesic intravenous paracetamol was used on the first day after surgery, and no further analgesic therapy was needed. To allow initial scarring and fixation of the kidney, the patients were advised to stay in bed in the dorsal position for 2 days. Mechanical methods of thromboprophylaxis (anti-embolism stockings, leg movements), and low-molecular-weight heparin, were used to prevent thromboembolic complications. One patient had a mild fever (38.7 °C) on the first day, but that resolved spontaneously. Although there was a retroperitoneal dissection there was no large extravasation, nor any other complication, especially haemorrhagic, infectious or thoracic. The patients had an uneventful discharge and the mean (range) hospital stay after surgery was 3.5 (2–5) days. The nephrostomy catheter was removed 5 days after taking the nephrostogram. There were no late complications secondary to the suture into the calyceal system, and no haemorrhage, infection or stone formation. The patients reported a subjective resolution of their initial symptoms. Ultrasonography and/or IVU showed the kidney at a higher position, with the patient erect, than before surgery (Fig. 6), with a mean (range) follow-up of 28 (7–60) months.

View Article: PubMed Central

ABSTRACT

Objectives: To report a technique of percutaneous endoscopic nephropexy, using a polyglactin suture passed through the kidney, in patients with nephroptosis.

Patients and methods: Four women presenting with symptomatic right nephroptosis underwent a percutaneous endoscopic nephropexy. An upper-pole calyx was accessed percutaneously and a 24-F working sheath was placed. Another needle access was made through a lower-pole calyx and a #2 polyglactin suture was passed into the renal pelvis. It was then pulled out through the upper-pole tract using the nephroscope. A retroperitoneoscopy was performed and the tip of the nephroscope was used to cause nephrolysis. After inserting the nephrostomy tube the polyglactin suture was passed into the subcutaneous tissue and then tied without too much tension, to avoid cutting the parenchyma.

Results: The operative duration was 33 min and the hospital stay after surgery was 3.5 days. The nephrostomy catheter was removed 5 days after surgery. There were no complications, especially no haemorrhagic, infectious, lithiasic or thoracic complications. The four patients were relieved of their initial symptoms, with a mean follow-up of 28 months. Ultrasonography and/or intravenous urography showed the kidney at a higher location with the patient standing.

Conclusions: This technique combines the nephrostomy tract used in percutaneous techniques with the suture and nephrolysis used in laparoscopic techniques. Moreover, this procedure seems to be safe, with satisfactory anatomical and clinical results and a lower morbidity. However, a larger series will be necessary to establish its long-term morbidity and success rate.

No MeSH data available.