Uretero lysis

Abstract

Surgery for retroperitoneal fibrosis (RPF) involving the ureters may be performed for a variety of disease processes. Typically, the patient is a middle-aged or older person with idiopathic involvement of the entire retroperitoneum. Many of these patients have had prolonged exposure to analgesic medication, especially of the ergot class, which has been associated with this condition (1). Symptoms of RPF may include nonspecific flank or back pain, fever, and malaise. Although severe cases manifest on intravenous pyelography with hydronephrosis and medial deviation of the ureters, in its early stages the disease process may be detected only on computed tomography or magnetic resonance imaging, with the discovery of a retroperitoneal mass. Easy ureteral catheterization is pathognomonic of RPF; thus, these patients usually have had stents placed prior to operative intervention. Although a short course of steroids may be beneficial in those with less advanced disease who may be poor surgical candidates (2), most patients will come to operation for definitive diagnosis and treatment. Some of these patients ultimately will be found to have secondary RPF owing to a malignant condition, usually lymphoma. Other nonmalignant etiologies for RPF include prior abdominal irradiation, ovarian pathology, inflammatory bowel disease, and abdominal aortic aneurysm. Obviously, treatment of the underlying cause is paramount in secondary RPF. © 2006 Humana Press Inc.