Safety analysis of ureterolysis for ureteric obstruction secondary to retroperitoneal fibrosis

Ureterolysis is an uncommonly performed surgery for management of retroperitoneal fibrosis. This study sought to utilize a large, multi-centered database to assess the short-term post-operative outcomes of patients undergoing ureterolysis surgery for retroperitoneal fibrosis.

Using the American College of Surgeons National Quality Improvement Program database, a retrospective review was conducted on patients who underwent ureterolysis for retroperitoneal fibrosis between January 1st, 2006, and December 31st, 2016. Patients who underwent ureterolysis for retroperitoneal fibrosis as a principle operative procedure by a urologist were included. Complications within 30 days of surgery were captured and organized based on the Clavien-Dindo classification system. The prevalence of secondary reconstructive urologic procedures performed at the time of ureterolysis (ureteroureterostomy, ureteroneocystostomy, and ureteroneocystostomy with psoas hitch/bladder flap) was determined.

One hundred patients (51 male, 49 female) were included in the cohort, with a mean age of 57 (IQR 43 and 66, respectively). Of these, six underwent a secondary urological procedure at the time of ureterolysis (1 ureteroureterostomy, 2 ureteoneocystostomy, and 3 ureteroneocystostomy with psoas hitch/bladder flap). The overall complication rate was 12%. Of the patients affected, 92% experienced only Clavien grade I or II complications (wound or urinary infection). Only one patient required return to the operating room (Clavien III) and there were no high-grade complications (Grade IV or V).

Ureterolysis for retroperitoneal fibrosis is an uncommonly performed surgery with generally low incidence of post-operative complications. Ureterolysis may represent a safe treatment option for ureteric obstruction secondary to retroperitoneal fibrosis.