Nephroptosis: if the operation is inevitable - choose the method

Selection is a traditional or laparoscopic nephropsychia

Do Operation? And maybe we will try without surgery? I will have an ugly scar on my side? I will need to lie for a week without climbing after the operation and I miss the session? Often you have to hear such and many other questions from patients held. Answering these questions must be said: What is more likely the operation is needed, as there are no other non-invasive methods to eliminate the disorder of urine outflow from the kidney, if the reason for this is nephroptosis. It depends on the stage of the disease, on the degree of violation of the outflow of urine from the kidneys, on the degree of arterial hypertension, from the presence of inflammation of the kidney - an integrated approach and, at the same time, individual, t.E. We consider indication to surgery, the presence of at least two symptoms in the presence of a kidney displacement by 1.5 vertebra.

So, the competent doctor put this diagnosis and offered an operation - «Bearing» kidneys - nephropsychia, probably offering several options. What not suggested? And you ask - what way? Most likely it will be a traditional band-up operation on a side of 10 cm, using as a fixing material, for example, the muscular flap - everything is correct, it is so in the last century, we (practicing urologists) came, and, I must say, for the most part we continue work on this technique today. What requirements we place before the operation today?

• Kidney must be securely fixed.
• Restored normal kidney bleed and urine outflow.
• Renal tissue should not be injured during surgery.
• Kidney must preserve physiological mobility.
• Disability to restore should appear shortly after the operation.

All aspects are observed, but at what price: a long stay in bed, long healing of the postoperative wound, the probability of postoperative hernia, cosmetic defect of the lumbar region (coarse scar), long period of rehabilitation (21 days of strict beddown and restriction of physical activity within 6 months after surgery ). The question is naturally arising - and is there an alternative? Today we can already say that there is an alternative - this is an endovideosurgical (laparoscopic or lumboscopic) operation.

What it is? With the help of a special tool, modern surgical equipment, in the presence of certain surgeon skills, an operation is performed that allows you to perform nephropsychias («Bearing» kidney) in compliance with all the requirements listed earlier using all the former, t.e as for open operations, techniques and techniques. The difference in access and technique to reduce the traumatic operation.

The advantages of laparoscopic nephropsychiasis before the traditional

Previously, we noticed that after the operation of nephropsychia, the symptoms did not disappear in the traditional way in patients and the question was raised: and whether it was necessary to operate at all, except for the scar of the body did nothing changed. In this case, the laparoscopic operation eliminates the likelihood of the appearance of the ugly scar or postoperative hernia, so we can talk about the fact that patients are not «Risk» not getting rid of the symptoms to be unsatisfied. Another advantage of laparoscopic access at nephropsychia - when performing simultaneous operations (at the same time two or three operations). For example, a young woman suffers from secondary infertility, sclerokystosis of ovaries, right-sided nephroptosis, - the patient appears a chance to get rid of everything in just one laparoscopic access.

Another one, in our opinion, the advantage - during a laparoscopic operation, the possibility of identifying the pathology of the organs, clinically earlier itself in any way and its elimination, for example - adhesive disease - spikes can be successfully disconnected.

Disadvantages of laparoscopic nephropsychia

• Need special equipment and tools.
• Separate operational.
• Personnel trained for laparoscopic operations.
• The presence of consumables.

But if there is equipment, operating, specially trained personnel, and the patient is ensured by consumables - there are no shortcomings. Thus, these are relative disadvantages.

Disadvantages when performing traditional nephropsychias in relation to laparoscopic

• Long stay in bed.
• Healing postoperative wound.
• Possibility of the development of postoperative hernia.
• Cosmetic lumbar defect.
• Long term rehabilitation.

As can be seen, due to the emergence of modern equipment and new techniques, endovoscopy firmly occupied its, rightfully worthy of place in the treatment of pathological kidney mobility.

From the history of the disease

The patient of 26 years was on treatment in a urological clinic with a diagnosis: «Bilateral Nephroptosis II. Pain syndrome. Sensomatic arterial hypertension». With the interval of 1 year, the patient was performed 2 operations - nephropsychia.

1st operation is made by the traditional method. The postoperative period amounted to 11 days, the term of complete rehabilitation 3 months.

After a year, a laparoscopic nephropsychia, a laparoscopic nephropsychia, a rating grid on the other side - the postoperative period - 3 days, the period of complete rehabilitation 1 month + cosmetic effect.

So draw conclusions and choices.