Clinical reappraisal and state of the art of nephropexy

Abstract

The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.

Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis

“…The renal Doppler ultrasound is a relatively mature technology, which is simple, economical, and non-invasive [ 10 ]. It can well determine the optimal mean artery pressure (MAP) for each patient [ 11 ].…”

Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture

“…Long proximal ureter strictures remain challenging for surgeons (10,11). End-to-end anastomosis with a tension-free and watertight state is not always possible in these cases, and in the current literature, such cases are proposed to be cured via ureteral replacement with ileal, downward nephropexy or auto-transplantation (12)(13)(14).…”

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

“…The presence of nephroptosis has been linked to direct trauma related to sports, childbirth and caesarean section but also to weight loss [ 51 , 52 , 53 ] due to the loss of the supporting perirenal and pararenal fat [ 54 ]. Some cases in our sample showed diminished kidney support, either by caesarean section [ 40 ], low body mass index [ 27 ] or hysterectomy [ 30 ].…”