Percutaneous endoscopic nephropexy with a percutaneous suture passed through the kidney

Abstract

ObjectivesTo report a technique of percutaneous endoscopic nephropexy, using a polyglactin suture passed through the kidney, in patients with nephroptosis.Patients and methodsFour 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.ResultsThe 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.ConclusionsThis 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.

A Systematic Review on Spinal Asymmetries in Case Studies of Unilateral Nephroptosis from a Viscerosomatic Point of View

“…According to our results, nephroptosis has shown to generate spinal adaptations, with a protective posture by means of a flank closure, achieved by lowering of the homolateral lower rib, iliac crest raising and/or homolateral side-bending, with multiple vertebral asymmetries. Our results also show that, in some cases, postural asymmetries disappear when the ptosis is corrected (in supine position [ 31 , 35 , 36 , 38 , 39 , 40 , 43 , 44 , 45 ] or after surgical treatment [ 27 , 29 , 31 , 34 , 42 ], but in some cases they only improve partly [ 28 , 33 ], probably as a consequence of a long-term attitude, long-term muscular activity and shortening.…”

“…All the selected articles studied only one case, except five of them, which presented case series [ 27 , 28 , 29 , 30 , 31 ] ( Table 1 ). However, in two of these studies, only the first case was included, because the rest did not meet the established selection criteria [ 30 , 31 ].…”

“…Pain was reported in 16 of the 19 articles included in the review. This pain was located in the abdominal area or ipsilateral flank in 84.62% of cases [ 27 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Pain could also affect the spine, involving the lumbar area [ 41 ] and the right spinal area [ 42 ], and even follow a radiating distribution from the abdominal and lumbar areas to the groin [ 43 , 44 ].…”

“…Analysis of the pre-intervention imaging tests shows the pathological descent of the kidney in all cases in the standing position, even to the level of the sacrum [ 33 ] ( Table 2 ). In those cases where an intervention was performed and post-intervention images were available, an improvement in the position could be observed [ 27 , 28 , 29 , 31 , 33 , 34 , 42 ], as shown in Table 3 .…”

“…In terms of postural attitude, homolateral flank closure to the side of the ptotic kidney was observed in all the cases included in the review, with the exception of the patient in the study by O’Reilly et al [ 30 ] and the second case of the article by Jungling et al [ 33 ]. This happens especially in standing, and it usually decreases or disappears after treatment, although not in all the cases [ 27 , 28 , 29 , 31 , 33 , 34 , 42 ]. The protective attitude was generated by one or more of the following postural adaptations: homolateral last rib lowering, homolateral iliac crest raising and/or homolateral side-bending.…”