CC BY
19
II. ХИРУРГИЯ
LAPAROSCOPIC NEPHROPEXY FOR SYMPTOMATIC NEPHROPTOSIS: FIRST EXPERIENCE. CASE REPORT
Ibragimov R.P., Issayev D.A., Madadov I.K.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan
МРНТИ 76.29.36
ABOUT THEАUTHORS R.P. Ibragimov - urologist, transplant-surgeon, head of kidney transplantation, urology and nephrology department, scientific manager. (rava747@mail.ru 87017472070);
D.A. Issayev - urologist, transplant-surgeon, kidney transplantation, urology and nephrology department. (dzhanibek@issayev.com 87477218977);
I.K. Madadov - urologist, kidney transplantation, urology and nephrology department (dominic89@mail.ru 87478397110).
Abstract K .
Laparoscopic nephropexy for symptomatic nephroptosis in 28 year old female with recurrent urinary nephroptosis laparoscopy
tract infection and flank pain. Postoperative 6 months follow with no signs of recurrent infection or pain.
Симптоматикалык нефроптоз бойынша жасалган лапароскопиялык нефропексияньщ алгашкы тэжирибес
Ибрагимов Р.П., Исаев Д.А., Мададов И.К.
А.Н. Сызганов атында?ы Улттык, ?ылыми хирургия орталы^ы, Алматы, Казахстан
nephropexy.
АВТОРЛАР ТУРАЛЫ Ибрагимов Р.П. - дэр!гер уролог - трансплантолог, буйрек трансплан-тациясы, урология жэне нефрология бел1мшес1н1ц менгерушс, Fылыми жетекш!. (rava747@mail.ru 87017472070)
Исаев Д.А. - дэргер уролог - трансплантолог, буйрек трансплантациясы, урология жэне нефрология белiмшесi. (dzhanibek@issayev.com 87477218977)
Мададов И.К. - дэргер уролог, буйрек трансплантациясы, урология жэне нефрология белiмшесi, кiшi Fылыми цызметкер (dominic89@mail.ru 87478397110)
Ацдатпа _
Бел ауруыжэне рецидивт несепжолдарыныц инфекциясы бар 28жасар наукаска симптоматикалык нефроп- Туйш сездер
тоз бойынша жасалынтан лапароскопиялык нефропексиядан кейiнгi 6 айлык бакылауда бел ауруы немесе инфек- нефроптоз, лапароскопии,
ция белплер '1 табылмады. нефропексия.
Первый опыт проведения лапароскопической нефропексии при симптоматическом нефроптозе
Ибрагимов Р.П., Исаев Д.А., Мададов И.К.
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан
ОБ АВТОРАХ Ибрагимов Р.П. - уролог -трансплантолог, заведующий отделением трансплантации почек, урологии и нефрологии, руководитель исследования. (rava747@mall.ru 87017472070)
Исаев Д.А. - уролог-трансплантолог, отделение трансплантации почек, урологии и нефрологии. (dzhanibek@issayev.com 87477218977)
Мададов И.К.- уролог, отделение трансплантации почек, урологии и нефрологии, младший научный сотрудник (dominic89@mail.ru 87478397110)
Аннотация
Лапароскопическая нефропексия при симптоматическом нефроптозе у пациентки 28 лет с рецидивной инфекцией мочевых путей и болевым синдромом в пояснице. Наблюдение в послеоперационном периоде в течение 6 месяцев без признаков рецидива инфекции или болевого синдрома.
Ключевые слова
нефроптоз, лапароскопия, нефропексия.
Introduction
Nephroptosis, also known as a floating kidney and renal ptosis, is a condition in which the kidney descends more than 2 vertebral bodies (or >5 cm) during a position change from supine to upright. The condition is often treated with nephropexy, a surgical procedure that secures the floating kidney to the retroperitoneum [1].
The mobile kidney was first described in the literature by Franciscus de Pedemontanus in the 13th century. Throughout the years, the condition was often left untreated. In 1864, Dietl first char-
Fig.1
In prone position right kidney at the level of L1-L3.
Fig. 2.
Patient in upright position and the kidney is at the level of L3-S1
\ P
^ I
JPt ... fmi
acterized the symptoms of acute nephroptosis as episodes of acute abdominal pain and vomiting when the patient was upright. [2,3] Throughout the 1870s, nephrectomy was used as a treatment option, but it was soon abandoned owing to its excessive morbidity. In 1881, Hahn in Berlin described the first nephropexy in which he affixed the ptotic kidney to the retroperitoneum via the perirenal fat using a lumbar incision. [4] In 1882, Bassini began using fascial sutures through the renal capsule to affix the ptotic kidney to the retroperitoneum-a procedure that is still in use today. [3]
The term nephroptosis was first coined by Gle-nard in 1885. Since then, more than 170 various treatments have been developed for the condition. [5] Following the developments of anesthesia and antisepsis in the late 19th century, enthusiasm for renal surgery drastically increased; at the end of the 19th century, nephropexy was the most common treatment used to manage nephroptosis by urologists. Many symptoms, including renal pain, lower urinary tract infections, weight loss, gastrointestinal tract issues, anxiety, palpations, and even hysteria were attributed to nephroptosis. [5] However, because of the inconsistency of diagnosis and symptoms, nephroptosis fell out of favor as an accepted medical diagnosis.
Nephroptosis is a fairly rare condition, and the number of radiological diagnoses exceeds the number of patients with symptoms attributable to the condition. Many studies have estimated that nearly 20% of women have nephroptosis revealed by routine intravenous urography, but far fewer (10%-20%) actually present with symptoms attributable to the condition. [6]
Symptomatic nephroptosis is more common in females, with a female-to-male ratio of 5-10:1. In addition, it is more common on the right side (70% of cases).
Of interest, nearly 64% of patients with fibro-muscular dysplasia of the renal artery also have ipsilateral nephroptosis. [3]
Case presentation
28 years-old woman was admitted to the hospital with flank, during the physical activity, and recurrent pyelonephritis. Previously she was prescribed antimicrobials with temporary remission. She also underwent several times double J stents placement with the recurrence of symptoms after the removal of stent-catheter. On intravenous pyelography right kidney on prone position it was at the level of L1 -L3 (Fig. 1), but in upright position it was at the level of L3 - S1 (Fig. 2).
She underwent laparoscopic nephropexy of the right kidney in our department. Patient was on lateral decubitus position.
32
BECTHMK XMPYPrMM KA3AXCTAHA № 2-2018
Port placement: camera troacar (10mm) was placed in paraumbilical area, working troacars (2 - 5 mm) were placed on midclavicular line subcos-tally and on iliac area on the right, respectively. One additional troacar (5mm) was placed on midclavicu-lar line subcostally on the left to abduct the liver. Peritoneum and Gerota's fascia were transected in the areas of lower and upper poles of right kidney. Kidney was dissected on it's lateral and posterior aspects subfascially. Then 3 cm wide and 10 cm long biomesh was sutured to the lower pole of kidney (Fig. 3) and traversed by posterior aspect of kidney to the upper pole. The proximal end of bio-mesh was sutured to the triangular ligament of liver and to the abdominal wall laterally.
Postoperatively patient was on bed regimen for up to 10 days. She was discharged on 11th postoperative day. She was on follow-up up to 6 months and within this period no recurrent flank or infection occurred. On control check-up intravenous pyelog-raphy repeated to the patient and the right kidney was at the level of L1 - L3 (Fig. 4).
Conclusion
Nephroptosis occurs in many young female patients due to multiple parturitions or quick weight
loss, but in rare cases it causes such symptoms as pain or infection. But in case of treatment we consider laparoscopic nephropexy as safe, effective and minimal invasive surgical option.
Fig. 3
Biomesh sutured to the lower pole and extended to the upper pole by posteriorly
Fig. 4
Three month after the surgery. In upright position, kidney is in normal level
References
1. Winfield H. Nephroptosis. The 5-Minute Urology Con- 4. suit. Philadelphia: Lippincott Williams and Wilkins; 2000. Vol 1: 368-9.
2. Dietl J. Wanderende Nieren und deren Einklemmung. 5. Wien Med. Wschr. 1864;14:563 (part I); 1864;14:579 (part II); 1864;14:593 (part III).
3. Hoenig DM, Hemal AK, Shalhav AL, Clayman RV. 6. Nephroptosis: a "disparaged" condition revisited. Urology. 1999 Oct. 54(4):590-6.
Hahn E. Die operative Behandlung der beweglichen Niere durch Fixation. Zentralbl Chirurgie. 1881. 29:449-556.
Barber NJ, Thompson PM. Nephroptosis and neph-ropexy--hung up on the past?. Eur Urol. 2004 Oct. 46(4):428-33.
Plas E, Daha K, Riedl CR, Hubner WA, Pfluger H. Long-term followup after laparoscopic nephropexy for symptomatic nephroptosis. J Urol. 2001 Aug. 166(2):449-52.
