Page 43 - World Journal of Laparoscopic Surgery

Laparoscopic Ureterolysis without Omentoplasty
In an average follow-up period of 31.2 months (25–63), all Even though this report is a retrospective study and the number
patients are asymptomatic, with an average creatinine of 1.52 of cases is low, it shows that LUWI without omentoplasty is feasible
(0.9–2.1) with a renal scintigraphy without an obstructive pattern. with good results in the medium-term follow-up.
No patients required neither corticosteroid therapy nor dialysis
after surgery. conclusIon
Laparoscopic ureterolysis with intraperitonealization without
dIscussIon omentoplasty is a safe and feasible surgical option and provides

Obstructive uropathy related to IRF is an uncommon but severe good results in medium-term, follow-up in patients, with IRF as we
disease that may cause renal loss with dialysis requirement. Prompt described in our case series.
diagnosis and appropriate treatment may prevent terminal kidney
1,2
disease. However, there is no standardized treatment. 3,4 references
In patients with OU associated with IRF, as discussed in our cases, 1. Tzou M, Gazeley DJ, Mason PJ. Retroperitoneal fibrosis. Vasc Med
there are two treatment options: medical treatment (corticosteroids 2014;19(5):407–414. DOI: 10.1177/1358863X14546160.
or methotrexate or tamoxifen or the combination of these drugs) 2. Miller OF, Smith LJ, Ferrara EX, et al. Presentation of idiopathic
with or without urinary stent or urinary stenting followed by a SUWI retroperitoneal fibrosis in the pediatric population. J Pediatr Surg
2003;38(11):1685–1688. DOI: 10.1016/S0022-3468(03)00590-6.
with or without corticosteroid therapy. 4,10,11 3. Hernández Fernández C, Subirá Rios D, Moralejo Gárate M, et al.
Medical treatment with urinary stenting demonstrated a Laparoscopic treatment of retroperitoneal fibrosis. Arch Esp Urol
10
success rate between 53% and 75%. Fry et al. reported a success 2017;70(4):468–474.
rate of 75% in 24 patients treated with prednisone associated with a 4. O’Brien T, Fernando A. Contemporary role of ureterolysis in
urinary stent for 13.7 months. But, after a follow-up of 60.9 months, retroperitoneal fibrosis: treatment of last resort or first intent? An
11
Ilie et al. reported that only 54% of the patients were either free analysis of 50 cases. BJU Int 2017;120(4):556–561. DOI: 10.1111/bju.
of corticosteroids therapy or urinary stent. These data indicate that 13915.
patients treated medically require a urinary stent for long periods 5. Duchene DA, Winfield HN, Cadeddu JA, et al. Multi-institutional
of time, which is associated with huge morbidity. survey of laparoscopic ureterolysis for retroperitoneal fibrosis.
Urology 2007;69(6):1017–1021. DOI: 10.1016/j.urology.2007.02.004.
Open ureterolysis with intraperitonealization or LUWI has 6. Simone G, Leonardo C, Papalia R, et al. Laparoscopic ureterolysis
shown success rates between 83% and 100%. 3–9 O’Brien and and omental wrapping. Urology 2008;72(4):853–858. DOI: 10.1016/
4
Fernando performed a prospective analysis of 50 patients who j.urology.2008.06.011.
underwent OUWI and showed a 94% success of urinary stent free 7. Elashry OM, Nakada SY, Wolf Jr JS, et al. Ureterolysis for extrinsic
5
without corticosteroid therapy a year after surgery. Duchene et al. ureteral obstruction: a comparison of laparoscopic and open surgical
evaluated 73 patients who performed LUWI in a multicenter study techniques. J Urol 1996;156(4):1403–1410. DOI: 10.1016/S0022-
and showed an 83% success rate 17.7 months after surgery with or 5347(01)65601-5.
6
without adjuvant corticosteroid therapy. Simone et al. with a few 8. Srinivasan AK, Richstone L, Permpongkosol S, et al. Comparison of
laparoscopic with open approach for ureterolysis in patients with
patients who underwent LUWI showed a success rate of 100% at retroperitoneal fibrosis. J Urol 2008;179(5):1875–1878. DOI: 10.1016/
37.7 months after surgery without adjuvant corticosteroid therapy. j.juro.2008.01.030.
7
When LUWI and OUWI were compared, Elashry et al. showed 9. Styn NR, Frauman S, Faeber GJ, et al. University of Michigan
that patients treated with LUWI had less morbidity, less blood loss, surgical experience with ureterolysis for retroperitoneal fibrosis: a
and less hospitalization with similar functional results than OUWI. comparison of laparoscopic and open surgical approaches. Urology
8
Srinivasan et al., in a series of 70 patients, showed that there were 2011;77(2):339–343. DOI: 10.1016/j.urology.2010.03.036.
no differences between the two techniques in the resolution of 10. Fry AC, Singh S, Gunda SS, et al. Successful use of steroids and
OU, but patients who underwent LUWI had less blood loss and ureteric stents in 24 patients with idiopathic retroperitoneal fibrosis:
9
less hospitalization. However, Styn et al., in his comparative a retrospective study. Nephron Clin Pract 2008;108(3):213–220. DOI:
10.1159/000119715.
study did not see differences between the two groups in terms of 11. Ilie CP, Pemberton RJ, Tolley DA. Idiopathic retroperitoneal fibrosis:
complications or transfusion requirements, but the success rate was the case for nonsurgical treatment. BJU Int 2006;98(1):137–140. DOI:
87.5% after OUWI, and 93.8% after LUWI. 10.1111/j.1464-410X.2006.06210.x.

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