Idiopathic retroperitoneal fibrosis: the case for nonsurgical treatment

OBJECTIVE To review a 10-year experience of medical treatment for idiopathic retroperitoneal fibrosis (RPF), a rare condition of unknown causes, which may obstruct the ureter and for which treatment includes ureterolysis and relief of obstruction, and medical treatment with steroids with or without immunosuppressive medication. PATIENTS AND METHODS Of 31 patients with RPF treated between 1996 and 2004, 28 had idiopathic disease. Ureteric stents were used to relieve the obstruction in all patients, 12 had previous nephrostomies, 16 were given steroids and only one was treated with ureterolysis. RESULTS In all, 28 patients were followed for a mean of 51.17 months; the symptoms were relieved in all cases. Renal function, where impaired, improved dramatically in all patients. Fifteen patients (54%) are free of stents and medication after a mean (range) follow-up of 60.9 (24–110) months. CONCLUSION Idiopathic RPF responds well to conservative management consisting of relief of urinary tract obstruction and steroids.