Contemporary role of ureterolysis in retroperitoneal fibrosis: treatment of last resort or first intent? An analysis of 50 cases

Abstract

This study suggests that for patients with ureteric obstruction caused by RPF, contemporary ureterolysis performed by a high-volume specialist team can successfully render patients stent- or nephrostomy-free without compromising renal function. The results suggest that ureterolysis should be considered in all patients who present with ureteric obstruction caused by RPF that does not respond quickly to standard treatment.

Current approach to diagnosis and management of retroperitoneal fibrosis

“…Intraoperatively, careful handling is required to avoid injury of the ureter, bowel and vessels. 9,11 Operation by expert surgeons is desirable. However, there are few chances for surgeons to train in this procedure due to the condition being a rare entity.…”

“…However, there are few chances for surgeons to train in this procedure due to the condition being a rare entity. 11 In addition to the standard open procedure, a laparoscopic procedure can be attempted, although it is technically more challenging. Although the morbidity is not negligible, the success rates for ureterolysis are reported to be 60-100% in contemporary series.…”

“…Although the morbidity is not negligible, the success rates for ureterolysis are reported to be 60-100% in contemporary series. 9,11 Development of new technology securing safety and efficacy is awaited.…”

“…In contrast, ureterolysis, an aggressive surgical treatment, is carried out to relieve ureteral obstruction and salvage renal function in selected patients, but the optimal indication for it is controversial. 4,6,[9][10][11] In the present review, we summarize the current concept of RPF, and discuss the optimal strategy for diagnosis and management.…”

“…Because of the good responsiveness to medical therapy, ureteral obstruction is usually managed conservatively with ureteral stenting or PNS. In contrast, ureterolysis, an aggressive surgical treatment, is carried out to relieve ureteral obstruction and salvage renal function in selected patients, but the optimal indication for it is controversial 4,6,9–11 …”