University of Michigan surgical experience with ureterolysis for retroperitoneal fibrosis: a comparison of laparoscopic and open surgical approaches.

OBJECTIVES: To compare our experience with open surgical ureterolysis (OU) and laparoscopic ureterolysis (LU) to determine any differences in success and convalescence. OU for extrinsic compression of the ureters secondary to retroperitoneal fibrosis effectively releases the ureters from the fibrotic environment in most cases. Reports have suggested that LU provides similar benefits, with a decreased intensity and duration of convalescence.

METHODS: We retrospectively reviewed the data from 22 patients who had undergone 25 ureterolysis procedures for retroperitoneal fibrosis from 1997 to 2006 at our institution.

RESULTS: LU was performed in 13 cases (10 patients) and a total of 16 ureters. No conversion to open surgery was required. OU was performed in 12 cases (12 patients) and a total of 16 ureters. LU was associated with a significantly shorter hospital stay than OU (mean 2.1 versus 5.9 days, P = .004). Laparoscopic intraperitonealization of the ureters was performed in 97.5% of all affected ureters compared with 50% with OU (P = .02). No difference was seen between the 2 groups in the performance of an omental wrap, postoperative creatinine level, complication rate, operating time, or transfusion requirement. With a mean follow-up of 30 months for the OU group and 24 months for the LU group, the success rate was 87.5% after OU and 93.8% after LU (P = 1.0).

CONCLUSIONS: The results of our study have shown that LU is a safe and effective surgical procedure for retroperitoneal fibrosis. LU offers similar results and a shorter hospital stay compared with OU and should be considered the technique of choice, when available.