Retroperitoneoscopic Nephropexy for Symptomatic Nephroptosis

Purpose: Recently, laparoscopic nephropexy has been performed using a transperitoneal approach. We evaluated the efficacy of a retroperitoneoscopic technique for symptomatic nephroptosis. Patients and Methods: Three men and two women with right nephroptosis underwent retroperitoneal laparoscopic nephropexy. Their symptoms were right flank pain, gross hematuria, or both. The mean body mass index was 18.7. Surgery consisted of complete dissection of the kidney, after which three sutures were placed between the renal capsule at the posterior lateral edge and the psoas or quadratus lumborum muscle. Silk sutures were used in all five patients. Results: Retroperitoneoscopic nephropexy was successful with no intraoperative complications. The mean operative time was 167 minutes, and the mean estimated blood loss was <10 mL in all five patients. The mean convalescence period was 19.6 days. A postoperative urogram with the patients both supine and erect revealed an improvement in renal function, decreased displacement of the kidney (less than one vertebral body), or both. All patients were satisfied with the clinical outcome during an average of 18 months of follow-up. Conclusions: Retroperitoneoscopic nephropexy is feasible for patients with symptomatic nephroptosis. We recommend nonabsorbable materials such as silk for fixation of the kidney to the psoas or quadratus lumborum muscle.