Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function?

Abstract

<b><i>Background:</i></b> The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). <b><i>Summary:</i></b> Medline research terms of “idiopathic retroperitoneal fibrosis” AND “ medical therapy” OR “ureteral stenting” OR “surgical treatment” were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. <b><i>Key Messages:</i></b> Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach.

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“…In the literature, most patients were given corticosteroids for the medical treatment of RPF. In addition, methotrexate, azathioprine, mycophenolate mofetil, and tamoxifen were use (8). In this case, a steroid was used in the initial diagnosis.…”

Role of transduodenal endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) for diagnosis of retroperitoneal fibrosis (Ormond’s disease)

“…Regarding clinical features, RPF may manifest with systemic symptoms such as fatigue, weight loss, and fever in coexistence with back, flank, or abdominal pain and potentially elevated inflammatory parameters [11,12,13,14]. The most frequent complication is a ureteral obstruction resulting in hydronephrosis and eventually renal failure, especially in patients with peri-iliac involvement [4,15,16].…”

Subcapsular renal collection of idiopathic origin: An exceptional entity

“…It is a principle in cases of obstructive uropathy, regardless of the etiology, to remove the double-J stent as early as possible. This is because it is associated with bladder irritability, pain, and an increased risk of infection 2 .…”