DETERMINATION OF SURGICAL TACTICS IN PATIENTS WITH NEPHROPTOSIS BASING ON CONTRAINDICATIONS TO LAPAROSCOPIC NEPHROPEXY

Introduction. The study of the literature indicates that the list of indications for laparoscopic nephropexy (LNP) in patients with nephroptosis meets the requirements of urological practice, but contraindications to this operation do not correspond. Aim of the research. Based on the modern approach to determining contraindications for LNP, to develop a rational treatment strategy for performing this operation in patients with nephroptosis, aimed at reducing the frequency and severity of complications. Materials and methods. The study included the results of examination and treatment of 208 patients with stage 2–3 nephroptosis. In 1987–2001 103 patients (control group) underwent nephropexy according to the Pytel-Lopatkin method, taking into account the contraindications to nephropexy existing at that time. In 2002–2012 62 patients (main group A) underwent LNP using a polypropylene mesh according to our patented method. At the same time, LNP was contraindicated in 43 outpatients (main group B), taking into account the author's list of contraindications. Results. The use of the author's list of contraindications made it possible to establish among the patients of the main group B absolute contraindications to LNP in 9.3%, relative – in 37.2%, temporary – in 44.2%, special contraindication to LNP – in 4 (9.3%), which contributed to the prevention of possible postoperative complications among them, and among patients of the main group A, compared with the control group, there was a statistically significant reduction in postoperative complications. Conclusion. Therapeutic tactics based on the author's list of contraindications is that the patients with absolute contraindications to LNP are recommended conservative treatment; with relative contraindications – when transferring the concomitant diseases from subcompensation to compensation and with temporary contraindications – in the treatment of these diseases, LNP is performed. And in patients with special contraindication to LNP (abdominal adhesive disease), open nephropexy is performed. A new list of contraindications to LNP in patients with nephroptosis can be recommended for wider implementation in urological practice, which may contribute to improving the quality of treatment of these patients.