Nephropexy, a procedure once well regarded and frequently employed, has become almost an obsolete operation, and through no fault of its own. In spite of this fate, two facts on which the rationale of the operation is based remain true: ( 1) nephroptosis directly and solely responsible for obstruction, painful symptoms and persisting infection does occur; (2) the condition may be permanently corrected by appropriate surgical procedure. Failure to meet the diagnostic and operative requirements imposed by these two facts has given rise to incorrect conclusions in three different groups of cases, and has earned for nephropexy its present disrepute.
In the first group of cases there is no significant abnormality of the upper urinary tract, the loose kidney being a mere incident and of no consequence. No other anatomic change in kidney or ureter is present and the symptoms are of extra-urinary tract origin, erroneous conclusions to the contrary being