title: Efficacy and complications of urinary drainage procedures in idiopathic retroperitoneal fibrosis complicated by extrinsic ureteral obstruction.
abstract: OBJECTIVE
  To investigate the efficacy and complications of urinary drainage procedures in patients with idiopathic retroperitoneal fibrosis complicated by ureteral obstruction.
  
  
  METHODS
  A retrospective study of 30 idiopathic retroperitoneal fibrosis patients involving 44 obstructed urinary units who underwent urinary drainage from January 2002 through April 2010 was carried out. Data of all diagnostic procedures, blood and urine cultures, and hospital admissions were collected and analyzed.
  
  
  RESULTS
  In 12 of 44 (27%) cases, percutaneous nephrostomy was carried out at the first step. Attempted ureteral stenting at the first step was successful in 25 of 32 (79%) cases, of which 20 (80%) cases could be managed successfully by ureteral stenting alone throughout the study period. Successful prolonged urinary drainage with percutaneous nephrostomy alone was accomplished in 10 cases, three at the first step and seven at the second step after failed intraureteral stent insertion or after unsuccessful maintenance of urinary drainage with an intraureteral stent. A total of 21 urinary tract infection episodes occurred in 11 patients. The incidence and accumulated incidence of acute pyelonephritis was 0.062 episodes/100 person-days and 30%, respectively. The incidence and accumulated incidence of urosepsis was 0.015 episodes/100 person-days and 6.6%, respectively. The overall number of complications did not differ between external and internal urinary drainage procedures (percutaneous nephrostomy, 21% vs intraureteral stent, 17.9%; P = 0.79).
  
  
  CONCLUSIONS
  Both intraureteral stent and percutaneous nephrostomy placement are a safe way to relieve urinary obstruction in idiopathic retroperitoneal fibrosis patients, and they have comparable complication rates. Over time, the need for using both management options in the same patient might be required. Hence, these techniques should be regarded as complementary.
authors.affiliation: Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Mertens
authors.forename: Antoine G M
authors.initials: AG
authors.lastname: Zeegers
authors.forename: Peter A
authors.initials: PA
authors.lastname: Wertheimer
authors.forename: Tadek R
authors.initials: TR
authors.lastname: Hendriksz
authors.forename: Eric F H
authors.initials: EF
authors.lastname: van Bommel
mesh_terms: D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000453:epidemiology; D012185:Retroperitoneal Fibrosis / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy*
keywords: intraureteral stent; percutaneous nephrostomy; retroperitoneal fibrosis; urinary drainage