title: Robotic ureterolysis for relief of ureteral obstruction from retroperitoneal fibrosis.
abstract: OBJECTIVE
  To review our experience with robotic surgery for the management of retroperitoneal fibrosis (RPF) with ureteral obstruction. Ureteral obstruction is common in retroperitoneal fibrosis RPF.
  
  
  METHODS
  Since April 2006, 21 patients have presented to our institution with ureteral obstruction, apparently from RPF. All underwent robotic biopsy. If frozen pathology reveals malignancy, is equivocal, and/or the fibrotic reaction is extensive, we stent the obstructed side(s) and await final pathology. If RPF is confirmed, medical therapy is initiated to relieve obstruction; failures receive salvage ureterolysis. Lymphomas are referred to medical oncology. If frozen pathology demonstrates RPF, immediate ureterolysis is performed, if technically feasible. Ureterolysis is not performed for uninvolved contralateral systems. We reviewed data with institutional review board approval.
  
  
  RESULTS
  Of 21 patients, 3 were diagnosed with lymphoma and 18 with RPF. Seventeen patients (21 renal units) with RPF received robotic ureterolysis (11 primary, 6 salvage); the other patient died of trauma before intervention. The only perioperative complication, an enterocutaneous fistula, required bowel resection. Three patients required a secondary procedure to relieve obstruction. At a mean follow-up of 20.5 months, no renal unit has evidence of obstruction, and all patients have improved or resolved symptoms. Furthermore, none of the 13 patients who underwent a unilateral ureterolysis have had disease progression to the contralateral side.
  
  
  CONCLUSIONS
  Robotic ureterolysis can be performed with minimal morbidity and provides durable success rates for relief of symptoms and obstruction in RPF. Biopsy remains integral to ruling out lymphoma. Empiric contralateral ureterolysis may not be necessary.
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY 10016, United States.
authors.forename: Aryeh Y
authors.initials: AY
authors.lastname: Keehn
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Mufarrij
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
mesh_terms: D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D004867:Equipment Design; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D010535:Laparoscopy / Q000379:methods; D008223:Lymphoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012185:Retroperitoneal Fibrosis / Q000473:pathology* / Q000601:surgery; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D014572:Urology / Q000379:methods