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      Percutaneous nephrostomy for symptomatic hypermobile kidney: a single centre experience

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          Abstract

          Introduction

          Symptomatic hypermobile kidney is treated with nephropexy, a surgical procedure through which the floating kidney is fixed to the retroperitoneum. Although both open and endoscopic procedures have a high success rate, they can be associated with risk of complications, relatively long hospital stay and high cost.

          Aim

          We describe our percutaneous technique for fixing a hypermobile kidney and evaluate the efficacy of the percutaneous nephrostomy insertion in management of symptomatic nephroptosis.

          Material and methods

          Between January 2005 and December 2011, 11 patients diagnosed with a symptomatic right nephroptosis of at least 1 year duration were treated with a single point percutaneous nephrostomy technique. All data were retrieved from patients’ medical records and then retrospectively analysed.

          Results

          Nephropexy through a single point percutaneous nephrostomy technique was successfully accomplished in 11 women. The mean operative time was 20 min. The intraoperative estimated blood loss was minimal in all cases. No major or minor intraoperative complications were noted. The average postoperative hospital stay was 2 days. Women returned to their usual activities 14 days following the surgery. Nine women had complete resolution of their pain, and 2 patients continued to complain of discomfort in their lumbar area. One patient was re-operated upon with satisfactory subjective and objective outcomes achieved. One patient refused re-operation.

          Conclusions

          Percutaneous nephropexy is simple, inexpensive and effective for treatment of symptomatic hypermobile kidney. It remains a valuable alternative to open, laparoscopic, and robotic methods for fixing a floating kidney.

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          Most cited references26

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          Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications.

          In this review the technique, indication for and complications of percutaneous nephrostomy (PCN) and antegrade ureter stent insertion are described. In the majority of the cases PCN is performed to relieve urinary obstruction, which can be of benign or malignant nature. Another indication for PCN is for treatment of urinary fistulas. PCN can be performed under ultrasound and/or fluoroscopic guidance, with a success rate of more than 90%. The complication rate is approximately 10% for major and minor complications together and 4-5% for major complications only. Percutaneous antegrade double-J stent insertion usually is performed if retrograde ureter stenting has not been successful. However, especially in malignant obstructions, the success rate for antegrade stenting is higher than for retrograde transvesical double-J stent insertion. In the case of severe infection and bleeding after PCN JJ-stent insertion may be contraindicated so long as there is no sufficient concomitant drainage via a PCN . Lower urinary tract dysfunction should be excluded before stent placement. The complication rate is 2-4%. Consequent stent surveillance with regular stent exchange is mandatory.
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            A review of radiologically guided percutaneous nephrostomies in 303 patients.

            To determine the morbidity and mortality associated with radiologically guided percutaneous nephrostomy (PCN) and to identify possible contributory risk factors. The authors retrospectively reviewed 454 consecutive PCNs in 303 patients performed during a 4-year period. PCNs performed specifically for nephrolithotomy were excluded. Self-retention loop catheters (8-12 F) were placed with use of a modified Seldinger technique in all patients. Preprocedural antibiotics were administered routinely. Demographic variables, technical factors related to tube placement, and risk factors were examined with respect to tube malfunction and 30-day morbidity and mortality. Technical success was 99%. The overall complication rate was 6.5%, including hemorrhage requiring transfusion after 13 PCNs (2.8%). A baseline platelet count of less than 100,000/mm3 was a significant risk factor for hemorrhage requiring blood transfusion. The 30-day mortality rate was 3.1%; however, none of these deaths were procedure related. Radiologically guided PCN with self-retention catheters is associated with a high technical success rate and low morbidity.
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              Nephroptosis: seriously misunderstood?

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                Author and article information

                Journal
                Wideochir Inne Tech Malo Inwazyjne
                Wideochir Inne Tech Malo Inwazyjne
                WIITM
                Videosurgery and other Miniinvasive Techniques
                Termedia Publishing House
                1895-4588
                2299-0054
                22 July 2014
                December 2014
                : 9
                : 4
                : 501-504
                Affiliations
                [1 ]Department of Urology and Urological Oncology, Medical University of Lublin, Lublin, Poland
                [2 ]Department of Urology, Medical College Jagiellonian University, Krakow, Poland
                Author notes
                Address for correspondence: Tomasz Golabek MD, PhD, Department of Urology, Medical College Jagiellonian University, 18 Grzegorzecka St, 31-531 Krakow, Poland. phone: +48 690 999 122. e-mail: elementare@ 123456op.pl
                Article
                23195
                10.5114/wiitm.2014.44168
                4280408
                0b048691-8aca-4660-a651-afcdffef0ccf
                Copyright © 2014 Sekcja Wideochirurgii TChP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 January 2014
                : 25 February 2014
                : 07 April 2014
                Categories
                Original Paper

                Surgery
                nephropexy,percutaneous nephrostomy,floating kidney
                Surgery
                nephropexy, percutaneous nephrostomy, floating kidney

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