Surgical technique of laparoscopic nephropexy using TVT (tension free vaginal tape) for patients with symptomatic nephroptosis



Surgical technique of laparoscopic nephropexy using TVT (tension free vaginal tape) for patients with symptomatic nephroptosis

G. Ameli, P. Weibl, W.A. Hübner
Landesklinikum Korneuburg, Urologie, Korneubrug, Österreich

Objectives: Persistently arising flank pain and/or functional impairment in an upright position - verified in split renal function test - constitute an indication for intervention. In keeping with the previously by Huebner et al. published technique, we report on laparoscopic nephropexy using TVT for symptomatic nephroptosis.
Material and method: After standardized laparoscopic mobilization of the lower pole of the kidney, identification of the ureter and renal pelvis, the needle of the TVT is directed below the lower pole of the kidney and pushed through the abdominal wall paravertebrally (under the level of 12th rib). Afterward it is pushed through the abdominal wall again and guided over the lateral margins of the kidney. The sling is tightened until the kidney is fixed to the dorsal wall of the abdomen in a “loose fit” manner. No further fixation or postoperative drainage are needed.
Results: Between 2000-2019, 21 women with symptomatic (n=19 right / n=2 left sided) and radiographically proven nephroptosis, were treated by laparoscopic nephropexy using TVT. Impairment in upright position at split function test was at least 5%. There were no intraoperative complications and only 3 pts required postoperative pain management according to ClavienDindo I. Postoperative intravenous pyelogram and ultrasound showed no recurrence in all cases after a mean follow up of 115.7 mts(range 3-227). 19 pts reported an improvement of symptoms, 2 complained about transient pain episodes 13 and 15 days, respectively. The visual analog score improved from 6.2 to 1.1.
Conclusion: Using a tension-free vaginal tape for laparoscopic nephropexy is a safe and technically feasible procedure. In fact, prospective studies as well as good clinical results in a bigger cohort may be appreciated.

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