title: Laparoscopic nephropexy: treatment outcome and quality of life.
abstract: BACKGROUND
  The recent introduction of laparoscopic procedures has markedly altered urological surgery. Laparoscopic nephropexy has attracted the attention of urologists as a treatment for nephroptosis. Herein, we describe our experiences and quality-of-life outcome of laparoscopic nephropexy and discuss its indications and surgical techniques.
  
  
  METHODS
  From May 1998 to February 2002, six female patients, ranging in age from 20 to 64 years (median age 39.8 years), with symptomatic nephroptosis underwent laparoscopic nephropexy. Mean preoperative downward kidney displacement was 2.25 vertebral bodies (range 2-2.5) and all affected kidneys were tilted at orthostasis. One patient underwent nephropexy through the transperitoneal approach and the remaining patients underwent nephropexy through the retroperitoneal approach. To evaluate surgical results, postoperative follow-up interview (pain visual analog scale and the short-form 36 (SF-36) health survey questionnaire) and objective examinations were performed.
  
  
  RESULTS
  All procedures were accomplished without complication. Postoperative intravenous pyelography correctly confirmed fixed kidney in both supine and erect positions. All patients reported an improvement of symptoms approximately 1 month after nephropexy and no symptoms have recurred during the follow-up period (range 6.3-50.7 months). On the SF-36, two domains, including role limitations due to emotional problems (RE) and mental health (MH), exhibited significant improvement postoperatively (P = 0.0405 and P = 0.0351, respectively).
  
  
  CONCLUSIONS
  Laparoscopic, in particular retroperitoneoscopic, nephropexy yields excellent outcomes and greatly improves general health-related quality of life, particularly mental status, as a minimally invasive treatment for symptomatic nephroptosis.
authors.affiliation: Department of Urology, Kurashiki Central Hospital, Kurashiki and Tohoku University, School of Medicine, Sendai, Japan. ym7856@kchnet.or.jp
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsuta
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Okubo
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome