Symptoms

• Increased renal pelvic pressure with vague back pain that often increases with intensity after an increase in fluid intake, nausea, vomiting, hematuria, urinary tract infection, pyuria, or hypertension

Diagnosis

• Intravenous urogram
• Renal ultrasound (US)
• A diuretic renal scan or antegrade pyelography would be equally helpful

Surgical Management

• Surgical correction of the UPI obstruction
• If immediate correction has to be delayed, then drainage and decompression of the renal pelvis must be initiated with a percutaneous nephrostomy tube or a double J catheter
• Surgical correction of the UPJ obstruction can include one of the following techniques:
  • Excision of the dysfunctional segment and repair (Anderson-Hines dismembered pyeloplasty, most common), antegrade (percutaneous)
  • Retrograde endopyelotomy (incision)
  • Antegrade (percutaneous) or retrograde lateral positioned cutting (electrified) wire using a low-profile (10 F) Acucise balloon cutting device (Applied Urology, Laguna Hills, CA).

References

• Baker LRI, Mallinson WJ, Gregory MC, et al: Idiopathic retroperitoneal fibrosis: A retrospective analysis of 60 cases. Br J Urol 60:497-503, 1988. Dalton RR, Donohue JH, Mucha P, et al: Management of retroperitoneal sarcomas. Surgery 105:725, 1989.
• Felix EL, Wood DK, DasGupta TK: Tumors of the retroperitoneum. Curr Probl Cancer 6:3, 1981.
• Koep L, Zuidema, GD: The clinical significance of retroperitoneal fibrosis. Surgery 82:250-257, 1977.
• Sheinfeld J, Eturk E, Spatano RF, et al: Peritoneal abscess:Current concepts. J Urol 127:191-194,1987.
• Wagenknect LV, Hardy JC: Value of various treatment for retroperitoneal fibrosis. Eur Urol 7:193-200, 1981.

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