Mediathek

Abstract

Symptomatic nephroptosis of the transplant: first report of successful minimal-invasive treatment

J. Huber¹, E. Nikitin¹, J. Putz¹, C. Thomas^1
1Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland

Introduction: Symptomatic nephroptosis of a kidney transplant is a rare and potentially fatal complication and requires fast diagnosis and treatment. In this report we describe a case in which intermittent symptomatic urinary obstruction and increased kidney retention parameters were the leading symptoms of nephroptosis. Increasing creatinine necessitated reinstertion of DJ-ureter stent and another removal attempt was unsuccessful. There was no stenosis, but hypermobility of the kidney as the suspected cause. We describe the diagnostic procedures and the successful minimal-invasive treatment.
Materials and methods: The operation was performed with the da Vinci Si-Surgical-System® (Intuitive Surgical) in a light Trendelenburg position. We chose a transperitoneal approach and fixed the upper kidney pole to the lateral peritoneum. We further performed an arched incision into the ventral peritoneum and flapped it over the transplant with a cranial fixation. Then we attached this “saftey belt” to the ventral aspect of the kidney transplant.
Results: Total surgery time was 86 minutes and estimated blood loss was 20 ml. The ureteral stent and the bladder catheter were removed on postoperative day 1 and the patient was discharged on postoperative day 3. Eight months later the patient is still asymptomatic with stable renal function.
Conclusion: To our knowledge this is the first report of a symptomatic transplant nephroptosis with consecutive intermittent urinary obstruction and without complications of perfusion solved with a minimal-invasive approach. Given the rarity of this event, prophylactic nephropexy could only be discussed in very special constellations. The treatment as described is straight forward, easy to perform and bears little stress for the patient.