Management of idiopathic retroperitoneal fibrosis from the urologist’s perspective

Surcel, C.; Mirvald, C.; Pavelescu, Cristian; Gingu, C.; Carmen, Savu; Huri, Emre; Ioanel, Sinescu

doi:10.1177/1756287214565637

Cited by 28 publications

(16 citation statements)

References 89 publications

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“…As for treatment, studies demonstrated that corticosteroids should be considered as the treatment of choice in RPF 14,15,17–19. Many immunosuppressive strategies were described in previous studies, and agents used in our cohort seem to reflect the lack of consensus in the management of RPF.…”

Section: Discussionmentioning

confidence: 90%

“…Various urologic interventions can be used to alleviate urinary obstruction and restore kidney function, but ureteral stent placement and ureterolysis are preferred 1,2,8,14,15. An interesting study showed that some patients underwent ureterolysis, intraperitonealization, and ureteral protection with PTFE vascular prosthetics.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, prednisone should be considered in patients with RPF 17. There are no other randomized trials comparing the different therapeutic options, but many case reports support the use of azathioprine, methotrexate, mycophenolate mofetil, tamoxifen, and cyclophosphamide 1,2,14,15,18,19. Several cases of spontaneous recovery are also reported 5,6,14,15…”

Section: Introductionmentioning

confidence: 99%

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Retroperitoneal fibrosis: retrospective descriptive study on clinical features and management

Laroche¹,

Bell²,

Bezzaoucha³

et al. 2016

RRU

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IntroductionRetroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function.MethodsWe conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital.ResultsWe identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18 years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes.ConclusionMost of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retroperitoneal fibrosis: retrospective descriptive study on clinical features and management

Laroche¹,

Bell²,

Bezzaoucha³

et al. 2016

RRU

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“…It also allows the differentiation of IgG4-related and IgG4-unrelated forms of RPF. Among the various techniques (open, laparoscopic, fine-needle, transcaval, CT-guided), a surgical biopsy remains the gold standard, with an opportunity to collect many deep specimens, which minimizes the risk of overlooking metastatic cells [24]. …”

Section: Diagnosticsmentioning

confidence: 99%

“…The advantage of a surgical procedure includes the possibility of surgical biopsy, which is important to exclude a neoplastic process [42]. There are more and more reports about the effectiveness and safety of laparoscopic ureterolysis, including procedures performed with the assistance of a robot [24]. On the basis of the above discussed research results, the algorithm of RPF management was proposed, and schematically presented in Figure 2.…”

Section: Treatmentmentioning

confidence: 99%

Retroperitoneal fibrosis – the state-of-the-art

2016

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Retroperitoneal fibrosis (RPF) is a rare disease, hallmarked by inflammation and deposition of fibrous tissue around the abdominal aorta. This process may spread contiguously and involve adjacent structures, leading to many complications, among which the most frequent and most severe is ureteral obstruction. The condition usually has idiopathic origin (idiopathic retroperitoneal fibrosis – IRF), but can also develop secondarily to a number of factors. The etiology of the disease remains unclear. Current research suggests that about half of the cases of IRF may be a symptom of a recently discovered, clinically heterogeneous immunoglobulin G4-related disease (IgG4-RD). Corticosteroids are the first-line treatment for IRF, but effective attempts to use immunosuppressants are also made. This paper presents the current state of knowledge on the etiopathogenesis, clinical presentation, diagnosis and therapeutic possibilities in different forms of RPF. Based on the latest research, an analysis of the relationship between IRF and IgG4-RD was performed.

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