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Titolo:
Retroperitoneal fibrosis: Cologne experience in conservative and surgical management
Autore:
Heidenreich, A; Derakhashani, P; Neubauer, S; Krug, B;
Indirizzi:
Univ Cologne, Klin & Poliklin Urol, D-50924 Cologne, Germany Univ CologneCologne Germany D-50924 klin Urol, D-50924 Cologne, Germany Univ Cologne, Inst Radiol, D-5000 Cologne 41, Germany Univ Cologne Cologne Germany 41 Inst Radiol, D-5000 Cologne 41, Germany
Titolo Testata:
UROLOGE A
fascicolo: 2, volume: 39, anno: 2000,
pagine: 141 - 148
SICI:
0340-2592(200003)39:2<141:RFCEIC>2.0.ZU;2-9
Fonte:
ISI
Lingua:
GER
Soggetto:
URETERAL OBSTRUCTION; GRAFT-SURGERY; COMPLICATION; DIAGNOSIS;
Keywords:
retroperitoneal fibrosis; immunosuppression; ureterolysis; surgery; radiology;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Heidenreich, A Univ Cologne, Klin & Poliklin Urol, Joseph Stelzmann Str 9,D-50924 Cologne, Germany Univ Cologne Joseph Stelzmann Str 9 Cologne Germany D-50924
Citazione:
A. Heidenreich et al., "Retroperitoneal fibrosis: Cologne experience in conservative and surgical management", UROLOGE A, 39(2), 2000, pp. 141-148

Abstract

Retroperitoneal fibrosis (RPF) is an uncommon inflammatory disease of the retroperitoneum leading to extensive fibrosis with consecutive obstruction of adjacent organs, namely the ureters. Since no consensus on the standard therapy exists, aim of the current study was to evaluate the outcome of 39 patients with RPF. Between 1986 and 1997 39 cases of RPF were diagnosed: 21cases had primary RPF and 18 patients had secondary RPF after aortofemoralgraft (n = 13), radiation (n = 2), or prior retroperitoneal surgery (n = 2). 21 patients demonstrated unilateral and 16 cases had bilateral hydronephrosis, in 2 patients no dilatation was observed. In 28 cases (n = 12 primary RPF, n = 16 secondary RPF) intial management consisted of DJ-stent placement, whereas in 11 cases(n = 9 primary RPF, n = 2 secondary RPF) percutaneous nephrostomy had to be placed. All patients received oral immunosuppressive agents (prednisolone 1 mg/kg, azathioprine 1 mg/kg/day) for 3 months before reevaluation was performed. In case of complete remission, immunosuppressive medication was continued for another 3 months, in case of stable disease or progression surgery was performed. In 26 cases (n = 15 primary RPF, n = 11 secondary RPF) ureterolysis with intraperitoneal displacement and omental wrapping was performed. 3 patients demonstrated complete remission after oral prednisolone/azathioprine; in 2 cases RPF presented as pelvic massand was resected followed by immunsuppressive therapy, in another 2 cases bilateral ileal replacement of the ureters had to be performed and 4 cases remained on DJ-stents and nephrostomy, resp. Postoperatively, all patients with primary RPF were continued on immunsuppressive medication for another 3 months. After a follow-up of 6 to 120 months only 3 patients developed a retroperitoneal recurrence and were treated by unilateral nephrectomy or DJstent placement (n = 2). Our data suggest that the combination of both immunosuppressive medication and surgical management results in an excellent longterm outcome in idiopathic retroperitoneal fibrosis with a recurrence rate of only 8%. Combination therapy should be considered as therapeutic option early in the course of the disease. Primary reconstructive surgery appears to be the most promising approach in secondary retroperitoneal fibrosis with a recurrence rate of only 5%; short external compression of the uretermight be managed by endoluminal balloon dilatation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/09/20 alle ore 23:01:07