Laparoscopic Ureterolysis for
Idiopathic Retroperitoneal
Fibrosis

Matsuda, Tadashi; Arai, Yasuhiro; Muguruma, Koei; Uchida, Junji; Shichiri, Yasumasa; Komatz, Y

doi:10.1159/000475401

Cited by 27 publications

(10 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

See 1 more Smart Citation

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…In that case, the fibrosis involved a wide area and it was difficult to free the ureter near the renal hilum laparoscopically. As reported by Matsuda et al ., laparoscopic ureterolysis may not be indicated in patients with a long ureteral stricture 4 …”

Section: Discussionmentioning

confidence: 99%

“…The treatment is usually surgical and the ureters must be freed from the fibrous plaque and shielded from the inflammatory process by intraperitonealization 1 . Recently, laparoscopic ureterolysis for retroperitoneal fibrosis has been described by Kavoussi et al ., 2 Puppo et al ., 3 Matsuda et al 4 . and Boeckmann et al 5 …”

Section: Introductionmentioning

confidence: 99%

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

et al. 2005

View full text Add to dashboard Cite

Three patients with idiopathic retroperitoneal fibrosis underwent laparoscopic ureterolysis. Two patients were bilateral cases which were performed successfully as a one stage procedure. Another patient, who was unsuccessfully treated, had a long ureteral stricture. Laparoscopic ureterolysis may be a useful alternative to open surgical management especially in bilateral cases, except for patients with a long ureteral stricture.

show abstract

“…En algunos casos puntuales informados en la bibliografía, la biopsia retroperitoneal y la ureterolisis mediante laparoscopia pudieron sustituir a las téc-nicas de cirugía convencional para el diagnostico y el tratamiento de la FRP, con menor morbilidad, menor coste hospitalario y de convalecencia [2][3][4][5] .…”

unclassified

Laparoscopia en la fibrosis retroperitoneal

Pérez

Santos

et al. 2005

Actas Urol Esp

View full text Add to dashboard Cite

CARTAS AL DIRECTOR P ese a que se sigue recomendando en los textos, la biopsia de la fibrosis retroperitoneal (FRP) para excluir un origen maligno, no es una costumbre habitual, puesto que muchas veces puede suponerse por la historia clínica y los medios de imagen el carácter idiopático o benigno, que supone la mayoría de los casos, y, por otra parte, el ensayo terapéutico con corticoides tiene baja morbilidad en la fibrosis de causa maligna. Sin embargo, la biopsia debería indicarse cuando se sospecha malignidad, es decir, en pacientes con antecedente de neoplasia de posible diseminación retroperitoneal, y cuando la fibrosis incluya las áreas retroaórticas, -en cuyo caso ha de considerarse el diagnostico de linfoma-, o se sitúe en lugares no típicos del trayecto ureteral 1 . Las indicaciones de ureterolisis en caso de resistencia a los corticoides o de compromiso ureteral grave son más generalmente asumidas.En algunos casos puntuales informados en la bibliografía, la biopsia retroperitoneal y la ureterolisis mediante laparoscopia pudieron sustituir a las téc-nicas de cirugía convencional para el diagnostico y el tratamiento de la FRP, con menor morbilidad, menor coste hospitalario y de convalecencia 2-5 .Como tuvimos ocasión de comprobar en una mujer de 62 años diagnosticada de FRP benigna, secundaria a periaortitis, con compromiso del uréter izquierdo, la biopsia y desplazamiento del uréter de la fibrosis que lo atrapa es posible mediante laparoscopia. Con la paciente en decúbito lateral y tres trócares situados en región paraumbilical (ópti-ca), subcostal e iliaca, el colon fue decolado y se identificó, en la porción más distal de la masa de fibrosis, el uréter con un catéter doble J en su interior. Trabajando con el endodisector en ángu-lo recto y la endotijera, se abrió la carcasa de fibrosis que rodeaba el uréter, quedando éste libre con cierta facilidad en una longitud de unos 10-12 cm, momento en el que el catéter doble J resultó muy útil, al dar consistencia a un uréter muy adelgazado, que pudo entonces ser manipulado con menos riesgo. El tejido fibrótico se biopsió en varios puntos con la endotijera, encontrando en el estudio intraoperatorio tejido inflamatorio benigno. A continuación el uréter fue desplazado lateralmente, fijándolo sobre el psoas, en una posición alejada de la fibrosis. Esta paciente estuvo hospitalizada 36 horas y está ahora bajo tratamiento con corticoides (Fig 1).

show abstract

Laparoscopic Ureterolysis for Idiopathic Retroperitoneal Fibrosis

Cited by 27 publications

References 6 publications

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

Laparoscopia en la fibrosis retroperitoneal

Contact Info

Product

Resources

About