Page 40 - World Journal of Laparoscopic Surgery

CASE REPORT
Laparoscopic Ureterolysis without Omentoplasty in the

Management of the Uropathy Secondary to Idiopathic

Retroperitoneal Fibrosis

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2
4
1
5
Miguel A Bergero , Patricio A Garcia Marchiñena , Guillermo Gueglio , Carlos David , Fernando Dipatto , Alberto Jurado 6
AbstrAct
Introduction: Obstructive uropathy (OU) secondary to idiopathic retroperitoneal fibrosis (IRF) is an infrequent disease, and the standard
treatment has not been established. However, ureterolysis with ureteral intraperitonealization is an effective therapeutic alternative. We present
the successful management of OU secondary to an IRF by laparoscopic ureterolysis without omentoplasty (LUWO).
Materials and methods: A retrospective descriptive study of 5 patients with IRF treated with LUWO was performed.
Results: The average age was 60.4 years. The average creatinine was 3.86 mg/dL. There were no intraoperative or major postoperative
complications. In a follow-up period of 31.2 months, all patients are asymptomatic, with an average creatinine level of 1.52 without dialysis
requirement. No patients required corticosteroid therapy after surgery.
Conclusion: Laparoscopic ureterolysis without omentoplasty is a safe and feasible option to treat the OU caused by IRF that provides good
results in the medium-term follow-up, as we describe it in our series of cases.
Keywords: Hydronephrosis, Laparoscopy, Retroperitoneal fibrosis, Ureteral obstruction.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1377

IntroductIon 1,4,5 Department of Urology, Sanatorio Privado San Geronimo, Santa Fe,
Obstructive uropathy (OU) related to idiopathic retroperitoneal Argentina
fibrosis (IRF) is a rare disease characterized by retroperitoneal 2,3,6 Department of Urology, Hospital Italiano de Buenos Aires, Buenos
fibrosis. The pathology has theorized to be an inflammatory Aires, Argentina
1,2
response to oxidized low-density lipoproteins. Because IRF has Corresponding Author: Miguel A Bergero, Department of Urology,
a very low prevalence, no treatments have been standardized. 3–5 Sanatorio Privado San Geronimo, Santa Fe, Argentina, Phone: +54
Surgical ureterolysis with intraperitonealization (SUWI) has been 34299960, e-mail: miguelangelbergeropizzi@gmail.com
considered as a definitive treatment for ureteral obstruction caused How to cite this article: Bergero MA, Garcia Marchiñena PA, Gueglio G,
by IRF. Usually, SUWI has been done open (open ureterolysis with et al. Laparoscopic Ureterolysis without Omentoplasty in the
intraperitonealization (OUWI)), with a high success rate, >90%. Management of the Uropathy Secondary to Idiopathic Retroperitoneal
But, with a high morbidity rate, ≥60%. Laparoscopic ureterolysis Fibrosis. World J Lap Surg 2019;12(3):126–129.
with intraperitonealization (LUWI) of the ureter with or without Source of support: Nil

omental wrapping has also shown a high success rate, >90% with Conflict of interest: None
a low morbidity rate <30%. 4–9 However, there is still no prospective
randomized study comparing both techniques. 7–9 The follow-up was performed with creatinine and renal
scintigraphy 1 month after surgery and then at 6 months.
MAterIAls And Methods The correct functioning of the kidney was considered an adequate

A retrospective multicenter descriptive study of 5 patients with renal function without requiring a urinary neither stent or dialysis
OU secondary to retroperitoneal fibrosis treated surgically with treatment.
laparoscopic ureterolysis without omentoplasty (LUWO) during
the years 2012 and 2017 was performed. Surgical Technique
The variables for the study were age, sex, symptoms at the Ureteral stenting was performed preoperatively. The patient was
time of pathology’s presentation, blood analysis [erythrocyte placed in an extended plank position. Four ports sites were placed
sedimentation rate (ESR), tumor markers, autoimmune disease according to the surgical technique (Fig. 1).
markers, creatinine], imaging studies (ultrasound, computed In the first step of the procedure, the line of told was incised, and
tomography or magnetic resonance, renal scintigraphy, positron the colon was deflected. The aorta and the external iliac artery were
emission tomography), corticoids treatment, ureteral catheter clearly exposed. Close to the aorta and riding the iliac artery, the
or nephrostomy. In addition, the variables related to the surgical encased ureter was identified and released from the fibrotic mass
intervention were evaluated: surgical time (minutes), intraoperative using a blunt instrument (Figs 2 and 3). Once the ureter has been
and postoperative complications (Clavien scale), bleeding (mL), pain completely released from the fibrotic tissue, along the full length
management with pain ladder of the World Health Organization between the renal pelvis and iliac vessels, we proceeded with the
(WHO) and time of hospitalization (hour). intraperitonealization of the ureter (Figs 3 and 4).

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