Laparoscopic treatment of retroperitoneal fibrosis.
OBJECTIVE
Retroperitoneal fibrosis (RPF) is an uncommon cause of ureteral obstruction. Surgical treatment is required in most cases. Open ureterolysis, although effective, is associated with significant morbidity and mortality rates. We present data on a series of 13 patients undergoing laparoscopic ureterolysis for RPF.


METHODS
Between December 1994 and October 2000, 13 patients with RPF underwent laparoscopic ureterolysis at our institution. Operative time, complications, estimated intraoperative blood loss, time to oral intake, amount of parenteral analgesics used, and length of hospital stay were reviewed. Postoperative pyelography or diuretic urography was performed to assess ureteral patency.


RESULTS
Laparoscopic ureterolysis was successful in 11 patients (85%); two conversions to open surgery were needed (15%). One patient required a laparoscopic Boari flap on one side because of intense fibrosis. Four postoperative complications (30%) were managed with conservative measures. At a mean follow-up of 30 months, intravenous urography or renal scan showed relief of obstruction in 92% of the patients.


CONCLUSIONS
Laparoscopic ureterolysis is an option to treat RPF. It is not free of complications and failures, and its precise role in the treatment of RPF still needs to be judged with longer follow-up and larger number of patients.
Fugita
Oscar Eduardo
OE
James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Jarrett
Thomas W
TW
Kavoussi
Parviz
P
Kavoussi
Louis R
LR
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012185:Retroperitoneal Fibrosis / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*