Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction

Matthias D. Hofer, Hugo J. Aguilar-Cruz, Nirmish Singla, Billy H. Cordon, Jeremy M. Scott, Allen F. Morey

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate renal mobilization with downward nephropexy as an adjunct maneuver to facilitate various methods of reconstruction of the upper urinary tract with limited ureteral length. Materials and Methods: We retrospectively reviewed all upper urinary tract reconstructive procedures performed from 2007 to 2015 to identify those requiring downward renal mobilization with nephropexy. Data including concomitant maneuvers, stricture location, prior surgeries, and intraoperative details were analyzed. Success rates, defined by resolution of symptoms and avoidance of further intervention, and complications were evaluated. Results: Of 92 patients undergoing ureteral reconstruction during the study period, 18 (19.6%) involved renal mobilization with downward nephropexy to gain additional ureteral length (5/7 [71.4%] of ureterocalycostomies, 8/26 [30.1%] of Boari flap bladder reconfigurations, 4/12 [33.3%] of ureteroureterostomies, and 1/12 [8.3%] of ileal ureters). Two-thirds of patients (12/18, 66.7%) had undergone unsuccessful prior open, laparoscopic, or endoscopic reconstruction attempts. Renal mobilization was performed open in 15/18 (83.3%) cases and laparoscopically in 3/18 (16.7%). After renal mobilization, the average distance of downward movement achieved was 3.3 cm (range 3-5 cm). With a mean follow-up of 50.4 months (range 3-87 months), overall success rate defined as ureteral patency was 88.9%, with 2/18 patients (11.1%) requiring a subsequent nephrectomy for failed upper tract reconstruction and persistent symptomatic hydronephrosis. Conclusion: Downward renal mobilization and nephropexy is a safe and versatile technique that can be effectively combined with many other reconstructive maneuvers.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Mar 4 2016

Fingerprint

Kidney
Urinary Tract
Hydronephrosis
Ureter
Nephrectomy
Pathologic Constriction
Urinary Bladder

ASJC Scopus subject areas

  • Urology

Cite this

Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction. / Hofer, Matthias D.; Aguilar-Cruz, Hugo J.; Singla, Nirmish; Cordon, Billy H.; Scott, Jeremy M.; Morey, Allen F.

In: Urology, 04.03.2016.

Research output: Contribution to journalArticle

Hofer, Matthias D. ; Aguilar-Cruz, Hugo J. ; Singla, Nirmish ; Cordon, Billy H. ; Scott, Jeremy M. ; Morey, Allen F. / Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction. In: Urology. 2016.
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abstract = "Objective: To evaluate renal mobilization with downward nephropexy as an adjunct maneuver to facilitate various methods of reconstruction of the upper urinary tract with limited ureteral length. Materials and Methods: We retrospectively reviewed all upper urinary tract reconstructive procedures performed from 2007 to 2015 to identify those requiring downward renal mobilization with nephropexy. Data including concomitant maneuvers, stricture location, prior surgeries, and intraoperative details were analyzed. Success rates, defined by resolution of symptoms and avoidance of further intervention, and complications were evaluated. Results: Of 92 patients undergoing ureteral reconstruction during the study period, 18 (19.6{\%}) involved renal mobilization with downward nephropexy to gain additional ureteral length (5/7 [71.4{\%}] of ureterocalycostomies, 8/26 [30.1{\%}] of Boari flap bladder reconfigurations, 4/12 [33.3{\%}] of ureteroureterostomies, and 1/12 [8.3{\%}] of ileal ureters). Two-thirds of patients (12/18, 66.7{\%}) had undergone unsuccessful prior open, laparoscopic, or endoscopic reconstruction attempts. Renal mobilization was performed open in 15/18 (83.3{\%}) cases and laparoscopically in 3/18 (16.7{\%}). After renal mobilization, the average distance of downward movement achieved was 3.3 cm (range 3-5 cm). With a mean follow-up of 50.4 months (range 3-87 months), overall success rate defined as ureteral patency was 88.9{\%}, with 2/18 patients (11.1{\%}) requiring a subsequent nephrectomy for failed upper tract reconstruction and persistent symptomatic hydronephrosis. Conclusion: Downward renal mobilization and nephropexy is a safe and versatile technique that can be effectively combined with many other reconstructive maneuvers.",
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