Retroperitoneoscopic nephropexy for symptomatic nephroptosis

Background: Open nephropexy for nephroptosis creates significant morbidity. We describe our technique for retroperitoneoscopic nephropexy and evaluate its efficacy. Methods: Twenty-five renal units in 23 patients with symptomatic nephroptosis underwent retroperitoneoscopic nephropexy by suturing the posterior renal capsules and transfixing them to the back muscles. The diagnosis and postoperative assessment were made by typical symptoms (via patient questionnaire) and findings of intravenous urography (IVU) when the position was changed from supine to erect. Results: Mean operative time was 188 min (range, 90-330). Mean narcotic use was 15.6 mg morphine. Complete resolution of symptoms occurred in 84% (21/25) renal units; 12% (three of 25) achieved partial improvement (> 75% decrease of preoperative symptoms). Follow-up IVU showed that 88% of patients had a renal descent of < 2 cm on standing; the others had a descent of 2-4 cm. All of the five renal units with hydronephrosis resolved completely after the operation. Conclusions: This modified technique of retroperitoneoscopic nephropexy is a minimally invasive, feasible, and highly successful option for treating patients with symptomatic nephroptosis.