Floating kidneys: a century of nephroptosis and nephropexy

Abstract

Purpose: Recently trained physicians are often unfamiliar with nephroptosis. Nephropexy, once a routine operation, almost disappeared from American practice more than 2 decades ago. In view of a recent revival of interest in nephroptosis and nephropexy in the American urological literature, a historical overview of nephroptosis and the evolution of surgical nephropexy is timely.

Materials and methods: A National Library of Medicine data base (1966 to 1996) search of "nephroptosis," "nephropexy" and "Dietl's crisis" was performed. Textbooks and monographs from the last 100 years were consulted. Original clinical descriptions and surgical accounts dating back more than 130 years were traced and reviewed.

Results: Nephroptosis and nephropexy have been subjects of controversy since Edebohls in New York popularized nephropexy in 1893. A close association with "neurasthenia" clouded objectivity prior to 1920. Nearly 200 surgical procedures were described. Urological opinion was often sharply polarized. In the last 2 to 3 decades the subject was largely eclipsed in the United States. Recently, however, new laparoscopic surgical techniques have been applied to the treatment of symptomatic nephroptosis.

Conclusions: Few diagnoses and surgical procedures have had such a contentious and colorful history. It seems likely that new criteria for diagnosis of symptomatic nephroptosis and the introduction of laparoscopic nephropexy will lead to renewed interest in the subject among generalists and specialists. Knowledge of the current literature can be enriched by an overview of the events of the last century.