1/10. Laparoscopic ureterolysis: technical alternatives.BACKGROUND AND PURPOSE: We describe our technique for laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis. Various options for tissue interposition are discussed, including management of bilateral disease. patients AND methods: 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. RESULTS: 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. CONCLUSIONS: 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.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
2/10. Multiple pulmonary hyalinizing granulomas associated with systemic idiopathic fibrosis.A 41-year-old man with progressive nodular infiltration of the lung of about 2 years' duration died of cardiac and respiratory failure. autopsy revealed bilateral multiple pulmonary hyalinizing granulomas (PHGs) diagnosed on the basis of the characteristic dense hyaline collagen bundles with nonspecific inflammatory infiltration. Constrictive pericarditis, retroperitoneal fibrosis, mediastinal fibrosis, fibrous thickening of the peritoneal and pleural surfaces, and fibrosis of soft tissue of the neck, flank, and hepatic hilar region were present, therefore, a diagnosis of systemic idiopathic fibrosis was made. The patient had anti-thyroglobulin and anti-thyroid microsomal antibodies and lymphocytic thyroiditis. The inflammatory process of PHG of the present case was active and the clinical course was progressive. PHG seems to be a lesion belonging to the systemic idiopathic fibrosis complex. Immunologic abnormalities may be related to PHG and systemic idiopathic fibrosis.- - - - - - - - - - ranking = 0.14720460186532keywords = flank (Clic here for more details about this article) |
3/10. retroperitoneal fibrosis.retroperitoneal fibrosis, an uncommon and ill-defined condition, has a variety of causes and presenting features. The fibrotic process often produces ureteral obstruction and compression of surrounding structures. Pain in the flank, lower abdomen or lumbosacral region is the most common presenting symptom. Certain drugs, neoplasms, retroperitoneal injury or infections may all initiate the fibrotic process. This article describes a case of retroperitoneal fibrosis in a 34-year-old man who had been receiving a beta-adrenergic blocking agent.- - - - - - - - - - ranking = 0.14720460186532keywords = flank (Clic here for more details about this article) |
4/10. Childhood retroperitoneal fibrosis.retroperitoneal fibrosis is rarely considered in the differential diagnosis of ureteral obstruction in children even when clinical presentation and radiologic findings are typical. In a 12-year-old boy admitted with a 2-week history of flank pain computed tomography showed an enhancing mass obstructing the left ureter. Pathologic examination of the mass and adjacent segment of ureter revealed retroperitoneal fibrosis.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
5/10. Idiopathic retroperitoneal fibrosis. A retrospective analysis of 60 cases.Sixty patients with idiopathic retroperitoneal fibrosis presenting between 1965 and 1984 are reviewed. Their mean age at presentation was 56 years and the male:female ratio was 3:1. The commonest presenting symptoms were flank and abdominal pain, weight loss, nausea and polyuria. physical examination was usually normal, expect for the presence of hypertension. Anaemia and elevation of erythrocyte sedimentation rate were usually present. proteinuria was found in less than a third of patients at presentation and significant bacteriuria was uncommon. The correct diagnosis was made or suspected in very few patients before referral. The cumulative actuarial survival rate was 86% at 1 year and 78% at 2 years. Seventeen patients died; they were significantly older and more uraemic at the time of referral than those who survived. A few patients did well with either corticosteroid therapy or ureterolysis alone. In the majority, both operation and steroid treatment were necessary. In bilateral obstruction with residual function in both kidneys, bilateral ureterolysis proved superior to unilateral operation (each followed by steroid therapy) in conserving renal function. Operation alone or steroid therapy alone should be considered in cases where steroids or surgery respectively present particular hazards. The less traumatic unilateral operation should be considered in poor risk patients and in those whose renal function is absent on one side. In many survivors, disease activity has persisted for many years. life-long follow-up is recommended.- - - - - - - - - - ranking = 0.14720460186532keywords = flank (Clic here for more details about this article) |
6/10. Perianeurysmal fibrosis and ureteric obstruction: case report and review of literature.A case of ureteric obstruction due to perianeurysmal fibrosis is reported and the literature reviewed. Reports of 56 previous cases showed striking male predominance, the presenting symptoms being abdominal pain, flank pain and back pain with radiation to the groin or leg. anuria occurred in 14.2%, and an abdominal mass was palpable in 45%. The pathogenesis and pathology of perianeurysmal fibrosis is discussed. The treatment of choice is bilateral ureterolysis and resection of the aneurysm, but in elderly, sick or uremic patients more limited procedures may be indicated.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
7/10. Idiopathic retroperitoneal fibrosis with functional duodenal obstruction.Idiopathic retroperitoneal fibrosis with duodenal obstruction is a rarely reported clinical entity. The presenting symptoms of nausea, vomiting, weight loss, and progressive fatigability can be easily overlooked if attention is focused on the more prominent symptoms of low back and flank pain. duodenal obstruction can present several months after the initial diagnosis of retroperitoneal fibrosis. nutritional support before surgical correction is imperative.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
8/10. breast cancer and retroperitoneal metastasis.retroperitoneal fibrosis is an uncommon disease of diverse etiology. carcinoma of the breast is rarely considered as a cause of retroperitoneal metastasis or fibrosis. This paper describes five patients with retroperitoneal fibrosis secondary to breast cancer. The mean duration from initial diagnosis to onset of symptoms was greater than ten years. The patients had received a variety of treatments for breast carcinoma and had extensive metastatic disease. Presenting symptoms included abdominal, flank, or low back pain. Two had small bowel obstruction and four had ureteral obstruction. It is possible that with long-term survival this complication may be seen more frequently.- - - - - - - - - - ranking = 0.14720460186532keywords = flank (Clic here for more details about this article) |
9/10. The clinical significance of retroperitoneal fibrosis.A total of 481 cases of retroperitoneal fibrosis (RPF) presented in the literature have been reviewed. Ten additional cases from this hospital have been added. One etiological factor, methysergide, has been implicated in 12.4 percent of cases, but the majority remain unexplained. Characteristically, the patient will be male (2:1 ratio), in his 50's (30.9 percent), with vague lower back pain (34.2 percent) or possibly flank pain (34.0 percent). physical examination usually will be unrevealing. The patient's serum chemistry probably will show some degree of azotemia (55.4 percent) and perhaps anemia (13.6 percent). The intravenous pyelogram characteristically shows bilateral hydroureteronephrosis (67.6 percent) or unilateral hydroureteronephrosis (20.3 percent) associated with medial deviation of the ureter due apparently to external compression of the ureter. methysergide should be discontinued if implicated. laparotomy for ureteral compression characteristically will reveal a dense, rubbery plaque in the retroperitoneum. Generous frozen section biopsies show fibrosis, usually with some chronic inflammation, suggestive of RPF. Careful inspection of retroperitoneal nodes and liver may reveal the presence of malignancy in 7.9 percent of patients. In the absence of malignancy, the ureters should lyse fairly freely and peristasis may return. If no malignancy is present on permanent sections of biopsy material, the patient can be given a fairly optimistic prognosis (cumulative mortality rate, 9 percent). Suboptimal improvement probably is an indication for steroid therapy and surgical re-exploration may become indicated. In these cases further search for malignancy should be undertaken.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
10/10. retroperitoneal fibrosis. A true connective tissue disease.retroperitoneal fibrosis, a disease that can occur at any age, is characterized by a periaortic fibrous mass that often surrounds the ureters, leading to ureteral obstruction. patients who present with this disease may complain of flank pain and acute renal failure. There is a high correlation with atherosclerotic disease of the aorta, although the pathogenesis of this disease remains unknown. Although recommendations for therapy remain empiric, prednisone seems to be efficacious in treatment; tamoxifen also may be effective. retroperitoneal fibrosis usually does not lead to long-term morbidity or affect survival.- - - - - - - - - - ranking = 1keywords = flank pain, flank (Clic here for more details about this article) |
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