Nephroplasty in the Management of Hydronephrosis

Smith, Patrick J.; Dunn, M.; Roberts, Julian

doi:10.1111/j.1464-410x.1979.tb04701.x

Cited by 4 publications

(6 citation statements)

References 3 publications

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“…The number of cases in this study is small, and not enough to demonstrate any statistically significant improvement in results. However, our results support other reports in the literature [9][10][11] and suggest that nephroplication is effective.…”

Section: Discussionsupporting

confidence: 89%

“…In the past, several authors have reported on the effect of nephroplasty or nephroplication for reducing intrarenal dilatation and improving drainage. Smith et al [9] performed a combined pyeloplasty and nephroplasty finding that the addition of nephroplasty was effective for reducing intrarenal dilatation and encouraging drainage from lower pole calyces. Goswami et al [10] reported a case with giant hydronephrosis in whom they performed a pyeloplasty with lower pole renal plication to provide gravity-dependent drainage of the inferior calyces.…”

Section: Discussionmentioning

confidence: 98%

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Surgical treatment and outcome of mega-hydronephrosis due to pelviureteric junction stenosis

et al. 2006

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To study the surgical treatment and outcome of hydronephrosis secondary to pelviureteric junction obstruction (PUJS) that is so massive that the renal pelvis crosses over the vertebral column [mega-hydronephrosis (MH)]. Of the 40 cases of PUJS we treated over the past 5 years, 6 cases had MH secondary to PUJS (MH-PUJS) in 6 renal units and were reviewed. Incidence of MH was 15.0%. All had Anderson-Hynes dismembered pyeloplasty to treat obstructive renal pattern on technetium-99m diethylenetriaminepentaacetic acid (DTPA) scans in five and gait disturbance due to MH in one. The contralateral kidney was normal in five and dysplastic in one. Three had nephrostomy before pyeloplasty. Preoperative DTPA scans showed good renal function in four and poor in two. Plication of the entire dilated, lax renal parenchyma ("nephroplication") was performed in three to decrease the intra-renal pelvic cavity. Prenatal diagnosis was performed in three cases. Mean age at pyeloplasty was 3.5 years and mean duration of follow-up was 1.5 years. Postoperatively, two of the three who did not have nephroplication had prolonged but not obstructed renal pattern on DTPA scans, and the other case who did not have nephroplication had nephrectomy for non-functioning kidney caused by recurrent pyelonephritis 2 years after pyeloplasty. In the three who had nephroplication, DTPA scans showed acceptable to relatively good passage in all cases. The surgical treatment of MH-PUJS is challenging with no fixed guidelines. However, nephroplication may be useful during pyeloplasty to decrease the size of MH-PUJS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 98%

Surgical treatment and outcome of mega-hydronephrosis due to pelviureteric junction stenosis

et al. 2006

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“…However, in such a situation most urologists would prefer to perform a formal dismembered pyeloplasty and hence it has not established a prominent place in the surgical management of hydronephrosis. Smith et al [ 17] performed a combined pyeloplasty and nephroplasty on 17 patients, finding that the addition of nephroplasty was a simple and effective way of reducing intrarenal dilatation and encouraging dependent drainage from the lower pole calyces. Sorrentino [ 7] performed a similar operation for giant hydronephrosis and reported satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis

Hemal

Aron

Wadhwa

1998

British Journal of Urology

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Objective To study the role of nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis, with an aim to reduce stasis and improve drainage, thus preventing consequent complications. Patients and methods Adjunctive nephroplication and nephropexy were performed in 20 renal units of 16 patients with giant hydronephrosis treated between January 1992 and March 1997. Twelve patients had unilateral and four had bilateral pelvi‐ureteric junction obstruction. Four patients had elevated serum creatinine levels. All patients were treated with definitive surgery for the underlying disease and an adjunctive nephroplication and nephropexy was performed at the same time. Results Eighteen of the 20 renal units with giant hydronephrosis showed an improvement in function and drainage as well as in pelvicalyceal system dilatation, while one remained unchanged and one deteriorated. None of the patients developed renal stones or pyelonephritis. Of the four patients with azotaemia, three showed definite improvement to normal levels while one stabilized. Conclusions Nephroplication and nephropexy of giant hydronephrotic kidneys are useful adjunctive procedures to reduce pelvicalyceal system stasis and to improve drainage, thereby preventing subsequent stone formation, infection and deterioration in renal function.

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“…Levitt et al [4] Calyco-ureterostomy Anastomotic stricture (thin ureteric lumen) Krzeski et al [5] Calycocystostomy Reflux; not possible in all cases Mandal et al [6] Boari flap calycovesicostomy Reflux/ stricture Stewart [7] Nephroplasty Primary pathology (UPJO) not corrected Smith et al [8] Nephroplasty + pyeloplasty May impede drainage due to kinking at UPJ Goswami et al [9] Lower pole renal plication Lower pole still dependent Hemal et al [2] Nephroplication + nephropexy (open) Morbidity of open surgery Figure 3. Nephropexy performed to assist drainage with gravity.…”

Section: Discussion/commentsmentioning

confidence: 99%

“…Several open surgical methods of improving drainage from a giant hydronephrotic pelvicalyceal system have been used including calycoureterostomy [4], calycocystostomy [5], Boari flap calycovesicostomy [6], nephroplasty [7,8], lower pole renal plication [9], and nephroplication with nephropexy [2]. Their advantages and disadvantages are outlined in Table 1.…”

Section: Discussion/commentsmentioning

confidence: 99%

Laparoscopic nephroplication and nephropexy as an adjunct to pyeloplasty in UPJO with giant hydronephrosis

et al. 2006

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Giant hydronephrosis due to uretero-pelvic junction obstruction (UPJO) is rare and usually the treatment is nephrectomy. When renal salvage is required, reconstruction of the UPJ alone is usually inadequate to improve drainage from the pelvicalyceal system. Various open surgical techniques have been described to improve gravity-assisted drainage from the giant hydronephrotic kidney. We describe, for the first time, a complete laparoscopic approach for pyeloplasty combined with nephroplication and nephropexy.

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Nephroplasty in the Management of Hydronephrosis

Abstract: Seventeen patients with hydronephrosis were treated by nephroplasty and pyeloplasty. This combination proved to be a simple and effective way of reducing intrarenal dilatation and encouraging dependent drainage from the lower pole calices.

Cited by 4 publications

References 3 publications

Surgical treatment and outcome of mega-hydronephrosis due to pelviureteric junction stenosis

Surgical treatment and outcome of mega-hydronephrosis due to pelviureteric junction stenosis

Nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis

Laparoscopic nephroplication and nephropexy as an adjunct to pyeloplasty in UPJO with giant hydronephrosis

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