Retroperitoneal fibrosis-clinical presentation and outcome analysis from urological perspective

Abstract

PurposeTo study clinical presentation, laboratory results, imaging findings and treatment options and outcomes of retroperitoneal fibrosis (RPF). To determine whether it follows the same natural course and response to treatment in the Asian population as in the Western world.Materials and MethodsMedical records of patients diagnosed with RPF on imaging and histopathology between February 2010 and April 2016 were reviewed.ResultsOf the 21 patients analyzed, mean age at presentation was 50.81 years. The male to female ratio was 0.9:1. Pain was most common presenting complaint (95.23% cases), almost 85% cases were idiopathic and rests were postradiation induced. The median creatinine level was 1.8 mg/dL. The mean erythrocyte sedimentation rate (ESR) was 53.2 mm/h. Hydronephrosis was present in all patients and 47.6% had atrophic kidneys. Diffuse retroperitoneal mass was present in 61.1%. Ureterolysis with lateralization, omental wrapping or gonadal pedicle wrap was done in 17 cases. Two patients underwent uretero-ureterostomy. One patient underwent ileal replacement of ureter, and one ileal conduit. Eighteen patients received concurrent medical treatment, 11 were given tamoxifen, 2 steroids (Prednisolone), and five were given both. Of the 20 patients with follow-up, 70% had complete symptomatic relief; ESR improvement was seen in 77.8%. Follow-up ultrasound showed resolved and decreased hydronephrosis in 20% and 55% respectively. One patient had treatment failure and 17.65% had disease recurrence.ConclusionsRPF is a rare disease with varied presentation and outcomes. The male to female ratio may be equal in Asians and smoking could be lesser contributing factor. More Asian cohort studies are required to support same.

Renal fungus ball in a patient with retroperitoneal fibrosis: Unique complication in a rare disease

“…To the best of our knowledge, this is the first report on the occurrence of renal fungal ball in a patient with RPF. This disease is characterised by chronic inflammation of the retroperitoneum, which leads to entrapment and obstruction of the peritoneal structures including the ureters . Consistent with the Review published studies, our patient also had ureteric obstruction which predisposed him to have renal fungus ball.…”

Arterio-Ureteral Fistula: Systematic Review of 445 Patients

“…16 In patients with aortitis or retroperitoneal fibrosis the ureter diverts medially and therefore forms more fistulas with the aorta. 17…”

A case of idiopathic retroperitoneal fibrosis presenting as gallbladder carcinoma

“…There were some similar typical cases published currently [14][15][16]; more details are provided in Table 1. Previous studies reported that abnormal laboratory findings included normochromic normocytic anemia, elevated inflammatory markers, abnormal renal function and positive autoimmune tests [10,17]. Some cases were accompanied by elevated serum IgG4 [9,18,19].…”

“…Furthermore, less common complications include lower-extremity edema with possible deep venous thrombosis, constipation, scrotal swelling, varicocele and hydrocoele. When symptoms of renal failure appear, there is a high probability of ureteral obstruction [10,11]. These symptoms are nonspecific and thus may not be helpful in the differential diagnosis.…”