Ureterolysis with omental wrap for bilateral hydronephrosis secondary to retroperitoneal fibrosis: A case report

The patient was a 62-year-old man who presented with general fatigue. Computed tomography and magnetic resonance imaging demonstrated bilateral hydronephrosis secondary to retroperitoneal fibrosis associated with abdominal (35 mm) and left and right common iliac aneurysms (23 and 16 mm, respectively). He was suffering acute renal failure with sCr of 5.3 mg/dL. Bilateral ureteral stents were placed and the level of sCr dropped to 1.6 mg/dL. He had been on chronic stent exchange for 20 months. Oral prednisolone (30 mg/d tapered to 5 mg/d for llmonths) did not improve the retroperitoneal fibrosis and only gave rise to steroid-induced diabetes. The bilateral ureteral stenosis became even worse and it became difficult for a guidewire to pass easily. There was concern regarding the development of ureteroarterial fistula. Mag3 renal scan demonstrated the left kidney to be non-functional. The patient underwent right ureterolysis with omental wrap and left nephrectomy. He then became stent-free without hydronephrosis. His sCr was 1.5 mg/dL 14 months post-op. Although it is underutilized in Japan, ureterolysis with omental wrap is an effective treatment option for patients with hydronephrosis secondary to retroperitoneal fibrosis.