Laparoscopic nephropexy using tension-free vaginal tape for symptomatic nephroptosis.

OBJECTIVES: Nephroptosis is a common incidental finding on routine excretory urography. It is characterized by descent of the kidney by more than 5 cm during orthostasis and is typically diagnosed in asthenic women. However, symptomatic nephroptosis is present in no more than 10% to 20% of cases. Currently, surgical correction of this benign disease is reserved for select cases in which well-documented nephroptosis causes persistent symptoms not amenable to conservative treatment. We report on laparoscopic nephropexy using tension-free vaginal tape (TVT) for symptomatic nephroptosis.

TECHNICAL CONSIDERATIONS: From 1999 to 2003, symptomatic nephroptosis was treated by laparoscopic nephropexy using TVT in 10 women aged 22 to 41 years (median age 30.2). After laparoscopic mobilization of the kidney, the needle of the TVT is directed below the lower pole of the kidney and pushed through the abdominal wall. Next, the tape is guided just over the lateral margin of the kidney and pushed through the abdominal wall. The kidney is now trapped in the tape. The sling is tightened until the kidney is securely fixed to the dorsal abdominal wall. The retroperitoneum is closed, and the ports are removed without leaving a drain.

CONCLUSIONS: Laparoscopic nephropexy for symptomatic nephroptosis using TVT is a technically feasible and safe procedure with excellent surgical and cosmetic results.