General knowledge of renal prolapse

  Under normal circumstances, the right kidney is located at the level of the first and second lumbar vertebrae, and the left kidney is about 2 cm higher than the right kidney. when the normal kidney is changed from the lying position to the upright position, the downward movement does not exceed one vertebra, if the downward movement exceeds two vertebrae, or exceeds 5 cm, it is called renal prolapse. Kidney prolapse is mostly seen in thin and long body type women, because they have shallow and wide kidney fossa, lack of fat around the kidney, weak and loose abdominal wall muscles, or insufficient abdominal pressure, the kidney lacks strong ligaments and surrounding tissues to play a fixed role, prone to kidney prolapse. Constipation and chronic cough are also triggers for the occurrence of renal prolapse. Most patients with renal prolapse have no subjective symptoms and are usually detected during physical examination. The degree of renal prolapse is not proportional to the severity of symptoms. Dietl crisis: It is a multi-symptom syndrome, due to angulation of ureter, prolapse of renal hilar pulling visceral nerve, narrowing of renal artery to renal ischemia, and finally acute hydronephrosis, manifested by intermittent renal colic, nausea, vomiting, chills, deficiency, rapid pulse, The symptoms are intermittent renal colic, nausea, vomiting, chills, weakness, rapid pulse, oliguria, transient hematuria and proteinuria, and the enlarged kidney can be found with tenderness.  Hypernephrosis is often followed by stones and recurrent urinary tract infections. Digestive symptoms include: bloating, belching, indigestion, nausea, vomiting, constipation and diarrhea. Patients with renal prolapse are often associated with neurosis, often with insomnia, fatigue, dizziness, and palpitations.  On physical examination, the active prolapsed kidney can be palpated in the lower abdomen during deep inspiration in the standing position.  Patients with renal prolapse are classified into three conditions: 1. asymptomatic renal prolapse; 2. symptomatic renal prolapse without combined functional changes; 3. symptomatic renal prolapse with combined functional or even morphological changes, or with severe urinary complications. Renal fixation surgery does not relieve the pain caused by pelvic-ureteral complications. Therefore, most symptomatic renal prolapse requires only symptomatic treatment, and only the third case is considered for surgical treatment.  I. Non-surgical treatment 1. Proper rest, increase nutrition, increase body weight if thin, exercise abdominal muscles, etc.  2.Local treatment: apply wide belt or kidney brace to tighten the waist to increase the abdominal pressure so that the kidney does not prolapse.  3.When accompanied by urinary tract infection or urinary tract stone, corresponding treatment measures should be taken.  Second, surgical treatment Open surgery is to fix the kidney on the ribs, lumbar rib ligament or lumbar square muscle, which is traumatic to the tissues and has many complications.  Currently, laparoscopic surgery is advocated to fix the kidney on the fascia of the lumbar square muscle and the upper edge of the hepatic sickle ligament. A mesh made of polypropylene material has also been applied to fix the kidney. The damage to the muscle is less and the long-term follow-up results are still satisfactory.