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Nephropexy: Surgical Fixation of a Floating Kidney

Nephropexy is a surgical procedure to fix a displaced or floating kidney (nephroptosis) back into its normal anatomical position in the retroperitoneum.

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Things worth knowing about "Nephropexy"

Nephropexy is a surgical procedure to fix a displaced or floating kidney (nephroptosis) back into its normal anatomical position in the retroperitoneum.

What is Nephropexy?

Nephropexy is a surgical procedure in which a displaced or abnormally mobile kidney -- a condition known as nephroptosis or floating kidney -- is surgically fixed back into its correct anatomical position within the retroperitoneum. The term derives from the Greek words nephros (kidney) and pexis (fixation). The goal of the procedure is to permanently stabilize the kidney in its proper location and to relieve associated symptoms.

Causes and Background: Why Does the Kidney Descend?

Under normal circumstances, the kidney is held in place by surrounding connective tissue, perirenal fat, and the pressure of adjacent abdominal organs. In nephroptosis, this support is weakened or lost, allowing the kidney to shift significantly downward when the patient stands or moves. Contributing factors include:

Significant weight loss leading to reduction of perirenal fat
Weak or lax connective tissue (connective tissue disorders)
Female sex and asthenic (slender) body type
Physical trauma or intense physical exertion
Multiple pregnancies

Symptoms of Nephroptosis

Many individuals with nephroptosis experience no or only mild symptoms. In symptomatic cases, the following complaints may occur:

Flank pain or back pain that worsens when standing or moving and improves when lying down
Colicky pain episodes resembling renal colic
Nausea and vomiting during severe pain attacks
Blood in the urine (hematuria)
Urinary obstruction due to kinking of the ureter (hydronephrosis)
Recurrent urinary tract infections due to impaired urine drainage

Diagnosis

Diagnosis of nephroptosis involves imaging studies performed in both standing and lying positions to document the extent of kidney displacement:

Ultrasound (sonography): First-line imaging to assess kidney position in standing and supine positions
Intravenous pyelography (IVP): X-ray examination with contrast agent to visualize kidney position and urinary drainage
CT urography or MRI: Detailed cross-sectional imaging for anatomical assessment
Renal scintigraphy: Functional imaging to evaluate kidney function in different body positions

Treatment: Nephropexy

Surgical fixation of the kidney -- nephropexy -- is indicated when conservative measures (such as weight gain, abdominal muscle strengthening, or wearing an abdominal support belt) are insufficient and symptoms significantly impair quality of life, or when complications such as hydronephrosis are present.

Surgical Techniques

Today, nephropexy is performed in most cases using a minimally invasive laparoscopic approach (keyhole surgery). The kidney is secured with sutures or a mesh to the fascia of the posterior abdominal wall or to a rib. Open surgical techniques, which were used in the past, are now rarely employed due to longer recovery times and higher complication rates.

Laparoscopic Nephropexy -- Procedure

General anesthesia is administered
Three to four small incisions (approximately 5-12 mm) are made in the abdominal wall
A laparoscope (camera) and surgical instruments are introduced
The kidney is mobilized and repositioned into its correct anatomical location
The kidney is fixed using sutures or a synthetic mesh to the posterior abdominal wall
Correct positioning is confirmed and wounds are closed

Retroperitoneoscopic Nephropexy

As an alternative, nephropexy can also be performed retroperitoneoscopically -- that is, via a posterior approach through the retroperitoneal space without opening the abdominal cavity. This technique reduces the risk of intraperitoneal complications.

Recovery and Outcomes

After laparoscopic nephropexy, most patients are discharged from hospital within 2-4 days. Full recovery typically takes 2-4 weeks, and strenuous physical activity should be avoided for several weeks. Studies indicate that laparoscopic nephropexy achieves significant pain reduction and improvement in quality of life in more than 80% of carefully selected patients with symptomatic nephroptosis.

Risks and Complications

As with any surgical procedure, nephropexy carries certain risks, which are generally low with the laparoscopic approach:

Bleeding or postoperative hemorrhage
Wound or urinary tract infection
Injury to adjacent structures (ureter, blood vessels, bowel)
Recurrence (kidney descending again)
Scar pain or mesh-related reactions

References

Hubner W. et al. -- Laparoscopic Nephropexy: Technique and Results. Urology, Springer Verlag, 2015.
Chapple C. R., Steers W. D. (eds.) -- Practical Urology: Essential Principles and Practice. Springer, London, 2011.
European Association of Urology (EAU) -- Guidelines on Urological Procedures, 2023. Available at: https://www.uroweb.org

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