Definition and Overview
Nephropexy refers to the surgical treatment of floating kidneys, a condition called nephroptosis.
Although the floating kidney surgery has been performed as early as the 1800s, it’s still a subject of controversy since some urologists believe that the condition doesn’t exist. For this reason, it is done only when the patient is showing clinical symptoms.
Who Should Undergo and Expected Results
The procedure is performed on patients who are officially diagnosed with nephroptosis, a condition characterised by the drooping of the kidneys, particularly the right one since it is usually lower when compared to the left kidney. Normally, the kidneys are fixed to the abdominal wall and held together by fascial or connective tissues, but they can also move significantly for a wide variety of reasons including having weak fascia.
Some of the most common signs and symptoms associated with this condition include hypertension (high blood pressure), chills, recurrent urinary tract infection, and excessive presence of blood and/or protein in the urine. A distinct feature of the disease is flank pain that tends to aggravate when the patient is lying down because the kidneys are obstructed.
Due to the possible complications associated with the surgery and the skepticism that surrounds it, the patient must exhibit all the symptoms and be diagnosed with the condition through image scans and tests like urography before the doctor will consider the surgery. And even if the patient has the condition, the surgery is considered as the last resort when other methods have failed to address the condition or reversed the symptoms.
Nevertheless, floating kidney surgery has a good success rate with no recurrence of the drooping of the kidney, based on some anecdotal studies with a follow-up of 10.5 months.
How Does the Procedure Work?
Although open surgery can be done especially in complex cases or when complications develop during the procedure, urologic surgeons now commonly use the laparoscopic technique since it shortens the procedure and offers faster recovery and fewer risks and complications.
In this method, at least three to four small incisions are made in the abdominal area where the affected kidney is “floating”. In one of the incisions, an instrument known as a laparoscope is inserted, which captures a live feed of the organ and the tissues adjacent to it so the surgeon can correctly identify the location of the affected kidney and plan the next steps more accurately. The area may also be filled with carbon dioxide to expand the space and make the organs and tissues more visible to the camera and screen.
Once the floating kidney is found, the other small incisions are utilized to manipulate microsurgical instruments to cut the kidney from its current position and move it to its proper place, securing it with dissolvable sutures. The incision is then closed.
Laparoscopic nephropexy takes less than 3 hours to complete and is performed under general anaesthesia. The patient is then advised to stay in the hospital for a few days following the procedure for close monitoring.
Possible Risks and Complications
Aside from the usual surgical risks and complications such as bleeding and infection, floating kidney surgery may also cause recurrent urinary tract infection and bruising in the retroperitoneal tissues and injury to surrounding organs like the liver. A trocar, a pointed three-sided device used to drain fluids in the abdominal cavity, may also accidentally puncture a bowel, causing a leak in the process. Other surgical instruments, meanwhile, may injure some nerves and blood vessels, which may cause profuse internal bleeding.
- Winfield H. Nephroptosis. The 5-Minute Urology Consult. Philadelphia: Lippincott Williams and Wilkins; 2000. Vol 1: 368-9.