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.