1986 Volume 77 Issue 2 Pages 328-331
Successful management of advanced retroperitoneal fibrosis by a ureteral substitution in a 56-year-old female is described. She had taken Senna as a purgative every day for over 10 years. She had dull pain in the left flank since February 1982 and in the right flank since January 1983. Her doctor diagnosed bilateral hydronephrosis in February 1982, but she had no further examination or treatment. In October 1983 the patient was transfered to our clinic because of non-functioning left kidney and marked right hydronephrosis. Right nephrostomy was performed for improvement of renal function. Antegrade pyeloureterography demonstrated a tapering stricture of the right ureter near the crossing of the iliac artery. A No 5 French ureteral catheter could not be passed through the narrowing of the ureter at 10cm proxymal from the ureteral orifice. On computerized tomogram the contrast material in the right ureteral leumen was surrounded by thick tissue. In February 1984 right uretero-ileocystostomy was performed. AT the operation the right ureter was enveloped by tough fibrous tissue, and was felt so hard like a string at the area of the obstruction that the obstructive portion of the right ureter was resected. On histological examination the fibrous tissue covering the ureter consisted of fibrosis with round cell infiltration. The ureteral mucosa exhibited a squamous metaplasia. The musclaris of the ureter was also affected by chronic inflammatory process and marked fibrosis. Convalescence was uneventful. The patient was well without obstruction 8 months after the operation.
