TREATMENT OF NEPHROPTOSIS
Treatment for symptomatic nephroptosis involves a surgical procedure called nephropexy which involves reattaching the ptotic kidney to its original anatomical site. This procedure can be performed laparoscopically and also da Vinci Robot assisted.
This surgical procedure can be considered for individuals suffering from severe nephrotic symptoms which affect the patients quality of life and/or if there is a functional disturbance or obstruction.
Individuals will usually only be offered nephropexy after careful consideration, investigations, imaging studies which support the diagnosis and a history of nephrotic symptoms usually >3 months.
As there is not yet a standard criteria regarding surgical treatment which has been defined for patients with symptomatic nephroptosis, some urologists will only perform nephropexy if renal ptosis is associated with nephrotic symptoms and an obstruction or functional change.
Although there has been several studies conducted which have demonstrated patients who had a confirmed diagnosis of renal descent with loin pain but no functional change or obstruction, still benefited from the surgery and experienced a marked improvement in their symptoms. The most recent edition of Springers Clinical Urology 2020 also suggests that not all symptomatic nephroptosis cases require a functional disturbance or change before repair.
Nephropexy surgery is usually performed by using non absorbable sutures to fixate the kidney to the fascia of the psoas major or quadratus lumborum muscle. The use of a polyglactin or polypropylene mesh is sometimes also used in addition to encourage adhesions. A transperitoneal or extraperitoneal approach can be used although surgical approaches and techniques will vary dependent on the urologist and on an individual case basis. As nephropexy can be performed laparoscopically using a minimally invasive approach allows individuals to experience less post operative pain, a shorter hospital stay and less risk of surgical complications.
Studies are continually emerging evaluating nephropexy for symptomatic nephroptosis and are continually demonstrating a high rate of success with either complete symptom relief or a significant improvement in individual's symptoms.
Complete resolution/ or significant reduction of nephrotic pain and symptoms
Significant improvement in the quality of life
Decreased occurrence of haematuria
Improvement in renal arterial blood flow
Resolution / reduction in urinary tract infections