Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

Okumura, Akiou; Murakami, Kazuhiko; Nozaki, Tomoyoshi; Fuse, Hideki

doi:10.1111/j.1442-2042.2005.01214.x

Cited by 15 publications

(13 citation statements)

References 4 publications

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“…Laparoscopic biopsy and ureterolysis are also possible [18, 19]. The ability to obtain a tissue diagnosis – and exclude malignancy – is one of the reasons commonly cited as an indication for this approach.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Steroids and Ureteric Stents in 24 Patients with Idiopathic Retroperitoneal Fibrosis: A Retrospective Study

et al. 2008

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Background/Aims: Retroperitoneal fibrosis (RPF) is a chronic inflammatory disorder causing obstructive nephropathy and renal failure. We reviewed our management of this condition. Method: All patients with RPF treated at a single center over a 15-year period were identified. A full review of notes and computer records was undertaken. Results: Data was available on 27 patients, 3 of which were excluded from later analysis. Diagnosis was based on clinical history and cross-sectional imaging. Retroperitoneal biopsy was undertaken in 3 patients. 96% had significant renal impairment at presentation with a mean serum creatinine of 688 µmol/l. 46% required emergency hemodialysis. All patients were treated with a combination of ureteric stents and/or steroids with an excellent clinical response. The mean best creatinine reached by the cohort was 136 µmol/l, and renal function remained stable in the long term. No patients required chronic dialysis. Ureteric stents were removed within 12 months and low-dose steroids were continued for a mean of 34 months. Recurrent disease was observed in 25% of patients, who all responded well to further steroid therapy. Mean duration of follow-up was 76 months. Conclusions: RPF is very effectively treated by a combination of ureteric stents and steroids, with excellent long-term results using this approach. Continued follow-up is advised because of the possibility of recurrent disease.

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Section: Discussionmentioning

confidence: 99%

Successful Use of Steroids and Ureteric Stents in 24 Patients with Idiopathic Retroperitoneal Fibrosis: A Retrospective Study

et al. 2008

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“…Importantly, recurrence of obstruction can be asymptomatic and therefore a long‐term follow‐up is necessary. Although there are several reports of minimally invasive approaches to ureterolysis, detailed descriptions of technique and decision‐making on approach are rare (Table 1) [2–17]. We present four patients who had a laparoscopic ureterolysis with omental wrap using four separate techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Classically ureterolysis has been performed through a large incision often in the midline, yet several groups have reported minimally invasive approaches [2–17]. Besides the obvious aesthetic benefits of laparoscopy, Srinivasan et al.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To describe various approaches for ureterolysis with an omental wrap using minimally invasive techniques, as surgery for idiopathic retroperitoneal fibrosis includes tissue biopsy, ureterolysis, and intraperitonealization or omental wrap. PATIENTS AND METHODS Since 2006 we have performed ureterolysis in four patients diagnosed with retroperitoneal fibrosis in two institutions. The ureterolysis in two cases was bilateral, using a standard laparoscopic approach for one case and a hand‐assisted technique for the other. Unilateral ureterolysis was completed using a standard laparoscopic approach in one case and was converted to a hand‐assisted technique in the other due to difficulty with ureteric identification. An omental wrap was used after ureterolysis for all renal units. RESULTS A minimally invasive technique was used for all ureterolysis procedures and none required open conversion. There was fascial dehiscence after surgery at the hand‐port site in one patient, and required re‐operation for wound closure. The median (range) hospital stay for all patients was 2.5 (2–10) days and the median blood loss was 100 (50–550) mL. No patient required a blood transfusion. At a median 16.5 (12–32) months of follow‐up, there was symptomatic and radiographic success in all patients. CONCLUSIONS Ureterolysis can be a challenging operation depending on the extent of the retroperitoneal mass. An understanding of various laparoscopic techniques can provide the flexibility for successful completion of nearly all of these procedures using a minimally invasive approach.

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“…Üreteroliziste uyulması gereken temel prensipler açık ve minimal invazif yaklaşımlar arasında farklılık göstermez (1). Ancak özellikle laparoskopik ve robotyardımlı laparoskopik üreterolizis serilerinde, cerrahın tercihine ya da tecrübesine dayandırdığı bazı seçimler yapabileceği ve buna göre teknikte bazı minör değişimler olabileceği belirtilmiştir (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Örneğin, ameliyattan önce yerleştirilen üreteral stentlerin yerin-de bırakılması ya da ameliyat bitiminde çıkartılması, intraperitonealizasyon ile yetinilmesi ya da hem intraperitonealizasyon hem de omental sarma yapılması, sadece üst üriner sistemin dilate olduğu taraftaki üreterlerin serbestleştirilmesi ya da standart olarak bilateral serbestleştirme yapılması gibi tercihler çoğunlukla cerrahın seçimine bırakılmıştır.…”

Section: Minimal İnvazif üReterolizisunclassified

“…Laparoskopik ya da robot-yardımlı laparoskopik yaklaşımda, üreter farklı seviyelerde etkilenmiş olabileceğinden, çeşitli port konfigürasyonları kullanmak gerekebilir. Laparoskopik serilerde, genellikle 4 ya da 5 port (2 ya da 3 tanesi 12mm, geri kalan 1 ya da 2'si 5mm) kullanılmıştır (14)(15)(16)(17)(18)(19)(20)(21)(22). Robotik serilerde ise 12mm'lik kamera portu, 2 ya da 3 adet 8mm'lik robot kolu portuna ilave olarak genellikle bir adet 5 mm'lik asistan portu kullanılmıştır (23-25).…”

Section: Minimal İnvazif üReterolizisunclassified

Retroperitoneal Fibroziste Cerrahi Tedavi: Nelere Dikkat Edilmeli?

Acar¹,

Esen²

2013

Endouroloji

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Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

Cited by 15 publications

References 4 publications

Successful Use of Steroids and Ureteric Stents in 24 Patients with Idiopathic Retroperitoneal Fibrosis: A Retrospective Study

Successful Use of Steroids and Ureteric Stents in 24 Patients with Idiopathic Retroperitoneal Fibrosis: A Retrospective Study

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

Retroperitoneal Fibroziste Cerrahi Tedavi: Nelere Dikkat Edilmeli?

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