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Nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis.

OBJECTIVE
To study the role of nephroplication and nephropexy as an adjunct to primary surgery in the management of giant hydronephrosis, with an aim to reduce stasis and improve drainage, thus preventing consequent complications.


PATIENTS AND METHODS
Adjunctive nephroplication and nephropexy were performed in 20 renal units of 16 patients with giant hydronephrosis treated between January 1992 and March 1997. Twelve patients had unilateral and four had bilateral pelvi-ureteric junction obstruction. Four patients had elevated serum creatinine levels. All patients were treated with definitive surgery for the underlying disease and an adjunctive nephroplication and nephropexy was performed at the same time.


RESULTS
Eighteen of the 20 renal units with giant hydronephrosis showed an improvement in function and drainage as well as in pelvicalyceal system dilatation, while one remained unchanged and one deteriorated. None of the patients developed renal stones or pyelonephritis. Of the four patients with azotaemia, three showed definite improvement to normal levels while one stabilized.


CONCLUSIONS
Nephroplication and nephropexy of giant hydronephrotic kidneys are useful adjunctive procedures to reduce pelvicalyceal system stasis and to improve drainage, thereby preventing subsequent stone formation, infection and deterioration in renal function.