Long-Term Outcome of Ureterolysis and Omental Wrapping for Idiopathic Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is a rare fibroblastic inflammatory process that involves the retroperitoneum over the lower four lumbar vertebrae and entraps one or both ureters.¹ One hundred years after the first description by Albarran, the treatment of choice for RPF-induced ureteral obstruction is still a matter of debate. This may be explained by the rarity of the disease and the different pathological subtypes.¹ The aim of the treatment is to preserve renal function and to keep patients free of stents.² We evaluated the long term functional outcome of ureterolysis and omental wrapping (UOR) for idiopathic RPF. Twenty-one patients (17 males and 4 females) were treated by UOR. After a median of 25 (interquartile range: 12–125) months, there were statistically insignificant changes in serum creatinine and estimated glomerular filtration rate (p=0.5 and 0.9, respectively). Renal function remained stable or improved in 12 (57%) of cases. Nine (21.4%) renal units still harboured double J stents. Preoperative hydronephrosis improved or stabilised in 90% of renal units. Intraoperative complications had been inflected in 5 (23.8%) patients and included ureteral injury, inferior vena cava injury, and duodenal serosal injury in 3 patients, 1 patient, and 1 patient, respectively. All were managed intraoperatively with no postoperative sequelae. In conclusion, UOR has a good long-term renal function outcome as it avoids internal ureteral stent fixation in 78.6% of renal units.