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Editorial comment

Editorial comment Percutaneous endoscopic nephropexy with a percutaneous 73 Megias A. Percutaneous nephropexy in the treatment of renal Some studies showed that there is an associated colo- ptosis. Arch Esp Urol 1999;52:250–6. nic malrotation and/or a long mesocolon which allow [4] Sze´ kely JG. Re. Laparoscopic nephropexy: Washington Univer- the kidney to move freely in medial or caudal direction. sity experience (letter to the editor). J Urol 1997;157:266. This would therefore require fixation together with the [5] Hoenig DM, Hemal AK, Shalhav AL, Clayman RV. Percutane- ous nephrostolithotomy, endopyelotomy and nephropexy in a kidney. single session. J Urol 1998;160:826–7. Most of the previous open surgical techniques and [6] Bishoff JT, Kavoussi LR. Laparoscopic surgery of the kidney. In: most of the minimally invasive techniques have been Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campbell’s performed by a retroperitoneal approach which may ex- urology. 9th ed. Philadelphia: Saunders; 2007. p. 1759–809 plain the poor results (poor symptomatic improvement) [Chapter 51]. [7] Lezrek M, Ammani A, Bazine K, Assebane M, Kasmaoui el H, in the past as this pathognomonic mechanism was not Qarro A, et al. The split leg modified lateral position for revealed. Also, none of the authors who have used trans- percutaneous renal surgery and optimal retrograde access to the peritoneal techniques have mentioned the finding of an upper urinary tract. Urology 2011;78:217–20. incomplete rotation of the colon. [8] Liatsikos E, Kyriazis I, Kallidonis P, Do M, Dietel A, Stolzen- In this article, the authors present a technique where burg JU. Pure single-port laparoscopic surgery or mix of techniques? World J Urol 2012;30:581–7. the kidney is fixed with an absorbable suture (2-polygl- [9] Wadstrom J, Haggman M. Laparoscopic nephropexy exposes a actin – Vicryl). The suture passes through the collecting possible underlying pathogenic mechanism and allows successful system and parenchyma instead of renal capsule and is treatment with tissue gluing of the kidney and fixation of the tied without tension in the subcutaneous tissue. Theoret- colon to the lateral abdominal wall. Int Braz J Urol 2010;36:10–7. ically there is a slight concern that this suture may cut [10] Lezrek M, Bazine KH, Amani A, Assebane M, Ghoundale O, through the kidney tissue. However, from our own expe- Qarro A, et al. V30 ‘tips and tricks’ of percutaneous surgery in the split leg modified lateral position: optimal simultaneous rience of inferior mobilisation of the kidney with a thor- anterograde and retrograde access. Eur Urol Suppl 2011;10:351. ough-and-thorough guidewire through the lower calyx for upper pole puncture during PCNL we may say that even with a much more solid guidewire no slicing of the kidney occurs. It remains to be seen however whether the intra-calyceal part of the suture can lead to stone formation. The mean operative time was only 33 min which is I believe the article ‘‘Percutaneous endoscopic nephro- shorter than any of the other methods. I believe that this pexy with a percutaneous suture passed through the kid- procedure could be performed as a day case or short- ney’’ is a new and stunningly simple point of technique. stay procedure. There have been reported different surgical tech- There is no doubt that this alternative technique is niques to fix mobile kidneys (ren mobilis) since Hans easy, probably safe, less time consuming and therefore first reported such a procedure in 1881. cost-effective. Clinical application will establish its Whereas for a century open nephropexy was per- long-term efficacy. formed suturing the kidney to the posterior ipsilateral abdominal wall, over the last decades laparoscopical Noor Buchholz and percutaneous techniques have been applied in a Director of Endourology & Stone Services, Dept. of Urology, minimally invasive fashion. Laparoscopy sutured the The Royal London Hospital, Bartshealth NHS Trust, London, kidney in the same place as in open surgery whereas per- UK cutaneous nephropexy used the formation of scar tissue E-mail address: noor.buchholz@gmail.com around a nephrostomy to anchor the kidney. Laparo- scopic nephropexy showed more promising results with a low morbidity. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Arab Journal of Urology Taylor & Francis

Editorial comment

Buchholz, Noor
Arab Journal of Urology , Volume 11 (1): 1 – Mar 1, 2013
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Publisher
Taylor & Francis
Copyright
© 2013 Arab Association of Urology
ISSN
2090-598X
DOI
10.1016/j.aju.2013.01.001
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Abstract

Percutaneous endoscopic nephropexy with a percutaneous 73 Megias A. Percutaneous nephropexy in the treatment of renal Some studies showed that there is an associated colo- ptosis. Arch Esp Urol 1999;52:250–6. nic malrotation and/or a long mesocolon which allow [4] Sze´ kely JG. Re. Laparoscopic nephropexy: Washington Univer- the kidney to move freely in medial or caudal direction. sity experience (letter to the editor). J Urol 1997;157:266. This would therefore require fixation together with the [5] Hoenig DM, Hemal AK, Shalhav AL, Clayman RV. Percutane- ous nephrostolithotomy, endopyelotomy and nephropexy in a kidney. single session. J Urol 1998;160:826–7. Most of the previous open surgical techniques and [6] Bishoff JT, Kavoussi LR. Laparoscopic surgery of the kidney. In: most of the minimally invasive techniques have been Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Campbell’s performed by a retroperitoneal approach which may ex- urology. 9th ed. Philadelphia: Saunders; 2007. p. 1759–809 plain the poor results (poor symptomatic improvement) [Chapter 51]. [7] Lezrek M, Ammani A, Bazine K, Assebane M, Kasmaoui el H, in the past as this pathognomonic mechanism was not Qarro A, et al. The split leg modified lateral position for revealed. Also, none of the authors who have used trans- percutaneous renal surgery and optimal retrograde access to the peritoneal techniques have mentioned the finding of an upper urinary tract. Urology 2011;78:217–20. incomplete rotation of the colon. [8] Liatsikos E, Kyriazis I, Kallidonis P, Do M, Dietel A, Stolzen- In this article, the authors present a technique where burg JU. Pure single-port laparoscopic surgery or mix of techniques? World J Urol 2012;30:581–7. the kidney is fixed with an absorbable suture (2-polygl- [9] Wadstrom J, Haggman M. Laparoscopic nephropexy exposes a actin – Vicryl). The suture passes through the collecting possible underlying pathogenic mechanism and allows successful system and parenchyma instead of renal capsule and is treatment with tissue gluing of the kidney and fixation of the tied without tension in the subcutaneous tissue. Theoret- colon to the lateral abdominal wall. Int Braz J Urol 2010;36:10–7. ically there is a slight concern that this suture may cut [10] Lezrek M, Bazine KH, Amani A, Assebane M, Ghoundale O, through the kidney tissue. However, from our own expe- Qarro A, et al. V30 ‘tips and tricks’ of percutaneous surgery in the split leg modified lateral position: optimal simultaneous rience of inferior mobilisation of the kidney with a thor- anterograde and retrograde access. Eur Urol Suppl 2011;10:351. ough-and-thorough guidewire through the lower calyx for upper pole puncture during PCNL we may say that even with a much more solid guidewire no slicing of the kidney occurs. It remains to be seen however whether the intra-calyceal part of the suture can lead to stone formation. The mean operative time was only 33 min which is I believe the article ‘‘Percutaneous endoscopic nephro- shorter than any of the other methods. I believe that this pexy with a percutaneous suture passed through the kid- procedure could be performed as a day case or short- ney’’ is a new and stunningly simple point of technique. stay procedure. There have been reported different surgical tech- There is no doubt that this alternative technique is niques to fix mobile kidneys (ren mobilis) since Hans easy, probably safe, less time consuming and therefore first reported such a procedure in 1881. cost-effective. Clinical application will establish its Whereas for a century open nephropexy was per- long-term efficacy. formed suturing the kidney to the posterior ipsilateral abdominal wall, over the last decades laparoscopical Noor Buchholz and percutaneous techniques have been applied in a Director of Endourology & Stone Services, Dept. of Urology, minimally invasive fashion. Laparoscopy sutured the The Royal London Hospital, Bartshealth NHS Trust, London, kidney in the same place as in open surgery whereas per- UK cutaneous nephropexy used the formation of scar tissue E-mail address: noor.buchholz@gmail.com around a nephrostomy to anchor the kidney. Laparo- scopic nephropexy showed more promising results with a low morbidity.

Journal

Arab Journal of Urology – Taylor & Francis

Published: Mar 1, 2013

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