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

Abstract

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.

Giant hydronephrosis: still a reality!

“…Uretero-calycostomy, calycocystostomy, and Boari flap calycovesicostomy can be done in selected cases with massive calyceal dilatation and severely compromised peristalsis within the collecting system. [24] Adult, and pediatric patients were followed up for a median of 25, and 28 months, respectively . Success rates of pyeloplasty were 70% in adults and 90.9% in children.…”

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

“…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.…”

“…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.…”

“…The double J stent was inserted antegradely. As we knew this kidney may not drain effectively, nephroplication was then carried out using three rows of 2-0 polyglactic acid suture on the anterior, and posterior surface of the kidney (Figure 2a, b) following the technique described by us earlier for open surgery [2]. The first group of sutures was placed and tied in a plicating fashion from the lower to the mid-polar region and the second group was similarly placed and tied from the upper to the mid-polar region.…”

“…Therefore, the relief of obstruction alone may not be adequate for renal salvage. Nephroplication and nephropexy are useful adjuncts to improve drainage after the relief of obstruction in these kidneys [2]. This has been demonstrated in open surgery.…”