Laparoscopic ureterolysis and omental wrapping in patients with retroperitoneal fibrosis and obstructive uropathy: a single-center experience.
OBJECTIVE
To analyze the outcomes with mid- to long-term follow-up of laparoscopic ureterolysis (LU) and omental wrapping in retroperitoneal fibrosis (RPF) with obstructive uropathy.


METHODS
Records of 9 patients with RPF who had obstructive uropathy at presentation and had undergone LU and omental wrapping at our center during January 2004 to June 2012 were collected and analyzed.


RESULTS
Six females and three males underwent LU for RPF. Underlying causes of RPF could not be found in 8 (89%) cases. Two patients underwent bilateral LU. Mean operative time and estimated blood loss were 213 minutes (range, 180-280 minutes) and 119 mL (range, 70-200 mL), respectively. No case required conversion to open surgery. The only significant intraoperative complication (1/9 [11%]) was ureteral injury, which was easily repaired intraoperatively. The postoperative complication rate was 44% (4/9). Most complications (75% [3/4]) were minor and did not need specific treatment. The mean follow-up period was 46 months (range, 4-72 months). The success rate at last follow-up was 89%.


CONCLUSIONS
Treatment of RPF is still controversial. Any future prospective randomized comparative trials seem unlikely in view of the low incidence of RPF. LU and omental wrapping in the setting of obstructive uropathy are safe and an effective alternative with a high success rate at mid- to long-term follow-up.
1 Department of Urology, Bhopal Memorial Hospital & Research Centre , Bhopal, India .
Nand Kishore
NK
Arvind
Onkar
O
Singh
Qutub
Q
Ali
Janak
J
Singh
Shilpi Singh
SS
Gupta
Surbhi
S
Sahay
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012185:Retroperitoneal Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014524:Urethral Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*