Laparoscopic ureterolysis: technical alternatives

We describe our technique for laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis. Various options for tissue interposition are discussed, including management of bilateral disease.

Patients found to have retroperitoneal fibrosis were offered laparoscopic ureterolysis with the option of treatment with anti-inflammatory medications preoperatively. The obstructed renal collecting system was decompressed preopeatively with a nephrostomy tube or Double-J stent to stabilize renal function. A four-port transperitoneal approach was used. Patients with bilateral obstruction were offered bilateral ureterolysis in the same operative session.

Case 1 was a 57-year-old man with right-ureteral obstruction in a solitary kidney, the left kidney having been lost to retroperitoneal fibrosis. The patient had right laparoscopic ureterolysis with omental interposition. Case 2 was a 45-year-old man with left-flank pain and left-sided hydronephrosis. He underwent laparoscopic ureterolysis with an omental wrap through a mesenteric window. Case 3 was a 56-year-old woman with a retroperitoneal mass causing bilateral hydronephrosis. The patient had left laparoscopic ureterolysis with omental interposition through a mesenteric window. In the same sitting, the patient was repositioned for right laparoscopic ureterolysis with interposition of a peritoneal flap.

The treatment of retroperitoneal fibrosis can be performed in a safe and effective manner through the laparoscopic approach. Interposition of omentum or peritoneum can be accomplished laparoscopically. Moreover, bilateral disease can be managed in a single session using this approach.