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*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Scopus citations

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)
Pages (from-to)232-236
Number of pages5
JournalUrology
Volume94
DOIs
StatePublished - Aug 1 2016

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction'. Together they form a unique fingerprint.

  • Cite this