Expanding Applications of Renal Mobilization and Downward Nephropexy in Ureteral Reconstruction.
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.


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.


CONCLUSIONS
Downward renal mobilization and nephropexy is a safe and versatile technique that can be effectively combined with many other reconstructive maneuvers.
Department of Urology, UT Southwestern, Dallas, TX.
Matthias D
MD
Hofer
Department of Urology, UT Southwestern, Dallas, TX.
Hugo J
HJ
Aguilar-Cruz
Department of Urology, UT Southwestern, Dallas, TX.
Nirmish
N
Singla
Department of Urology, UT Southwestern, Dallas, TX.
Billy H
BH
Cordon
Department of Urology, UT Southwestern, Dallas, TX.
Jeremy M
JM
Scott
Department of Urology, UT Southwestern, Dallas, TX. Electronic address: allen.morey@utsouthwestern.edu.
Allen F
AF
Morey
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult