Multi-institutional Survey of Laparoscopic Ureterolysis for Retroperitoneal Fibrosis

Objectives: Medical therapy often fails to cure benign retroperitoneal fibrosis (RPF), necessitating a surgical approach. Preoperative and postoperative adjuvant medical therapy and the timing of surgical intervention are not well-established. We surveyed centers of laparoscopic excellence to determine the current practices in the treatment of RPF. Methods: Surveys were sent to all institutions with Endourological Society-recognized fellowships. The data collected were analyzed for trends in the treatment of RPF. Additional information was collected from participating institutions to better characterize the experience with laparoscopic ureterolysis and adjunctive medical management. Results: Of the surveys sent out, 17 completed surveys were returned (41%). A total of 73 patients had been treated for RPF. Most centers (13 of 17) used a conventional laparoscopic approach with rare conversion to hand assistance. The medical management of RPF was directed by urologists, rheumatologists, or other specialists in 59%, 24%, and 18% of institutions, respectively. Steroid therapy was administered preoperatively by 15 of 17 centers. Postoperatively, 10 of 17 centers continued treatment with steroids and/or cytotoxic agents. Eight institutions provided data on 46 renal units in the second part of the study. The success rate of laparoscopic ureterolysis per renal unit was 83% (38 of 46). No difference was seen in the outcomes of patients who received adjuvant medical therapy compared with those who did not (16 of 19 versus 22 of 27; P = 0.48) after a mean follow-up of 17.7 months. Conclusions: The results of this study have shown that no uniform treatment algorithm exists for RPF at centers of laparoscopic excellence. Most institutions recommended an attempt at steroids followed by laparoscopic ureterolysis. Laparoscopic ureterolysis had a high success rate, and adjuvant medical therapy did not appear to contribute to the success rate.