eMedicine Specialties > Urology > Hydronephrosis and Ureter Disorders

Retroperitoneal Fibrosis: Follow-up

Author: Chandra Shekhar Biyani, MBBS, MS, DUrol, FRCS(Urol), FEBU, Consulting Urologist, Department of Urology, Pinderfields General Hospital, UK
Coauthor(s): Joby Taylor, MB, ChB, MRCS, Specialist Registrar in Urology, Yorkshire Deanery, UK; Anthony J Browning, MB, ChB, FRCS(Edin), Consultant Urological Surgeon, Associate Director of Medical Education, Mid Yorkshire NHS Trust, Pinderfields General Hospital; Training Program Director for Urology, Yorkshire and Humber Deanery, UK
Contributor Information and Disclosures

Updated: Jun 9, 2009

Follow-up

Further Inpatient Care

  • After relief of long-standing obstruction, a physiologic diuresis is expected. This is usually a self-limiting process and can be managed conservatively with fluid and electrolyte replacement.
  • Urea diuresis is the most common. It is self-limiting, lasting 24-48 hours. Monitoring of fluid balance and electrolytes is required. Unless otherwise contraindicated, increased oral fluid intake should suffice.
  • Sodium diuresis is the second most common postobstructive diuresis. It usually is self-limiting but may have a longer duration (>72 h). Monitor fluid balance and electrolytes more aggressively (ie, intake and output [I/O], central venous pressure [CVP], urine and serum electrolytes).
  • Ultrasonography may be used to assess hydronephrosis.

Further Outpatient Care

  • Biochemical markers (eg, CRP, ESR, renal function) should be monitored every 4-8 weeks to assess the response.
  • Radiologic assessment (eg, CT scanning, MRI) is performed every 3 months; once disease is stabilized, scanning can be repeated at 6 months.
  • Recurrence of stenosis has been reported as late as 10 years; thus, long-term follow-up is necessary.
  • Patients with renal failure should be referred to a nephrologist early in the course of their disease and have continued nephrologic follow-up.

Complications

Prognosis

  • The natural history of retroperitoneal fibrosis (RPF) has not been clearly established. However, the outcome of nonmalignant retroperitoneal fibrosis is generally good.67
  • The prognosis of malignant retroperitoneal fibrosis is poor.

Patient Education

  • Patients with renal failure should be educated about the importance of compliance with secondary preventative measures, natural disease progression, prescribed medications (highlighting their potential benefits and adverse effects), and diet.

Miscellaneous

Medicolegal Pitfalls

  • Because of the nonspecific clinical symptoms, the diagnosis of retroperitoneal fibrosis (RPF) is often overlooked in younger patients.
  • Renal recovery is usually observed within the first 2 weeks. Checking these patients periodically is always better because some patients may regain renal function much later.

Special Concerns

  • Tamoxifen studies have shown that women who take high doses of tamoxifen over a long period may have a slightly increased risk of developing uterine cancer.
 


More on Retroperitoneal Fibrosis

Overview: Retroperitoneal Fibrosis
Differential Diagnoses & Workup: Retroperitoneal Fibrosis
Treatment & Medication: Retroperitoneal Fibrosis
Follow-up: Retroperitoneal Fibrosis
Multimedia: Retroperitoneal Fibrosis
References
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Further Reading

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Keywords

retroperitoneal fibrosis, RPF, periureteric fibrosa, periureteric plastica, periureteric fascitis, perinephritis plastica, ceroid, Ormond's disease, Ormond's syndrome, Ormond disease, Gerota's fascitis, Gerota fascitis, peripyelitis plastica stenosans, sclerosing lipogranuloma, sclerosing retroperitonitis, ureteral obstruction, ureteral entrapment, periureteritis, sclerosing retroperitoneal granuloma, chronic periaortitis, hyper-IgG4 syndrome

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Contributor Information and Disclosures

Author

Chandra Shekhar Biyani, MBBS, MS, DUrol, FRCS(Urol), FEBU, Consulting Urologist, Department of Urology, Pinderfields General Hospital, UK
Chandra Shekhar Biyani, MBBS, MS, DUrol, FRCS(Urol), FEBU is a member of the following medical societies: British Association of Urological Surgeons, British Medical Association, European Association of Urology, and International College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Joby Taylor, MB, ChB, MRCS, Specialist Registrar in Urology, Yorkshire Deanery, UK
Joby Taylor, MB, ChB, MRCS is a member of the following medical societies: British Medical Association and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

Anthony J Browning, MB, ChB, FRCS(Edin), Consultant Urological Surgeon, Associate Director of Medical Education, Mid Yorkshire NHS Trust, Pinderfields General Hospital; Training Program Director for Urology, Yorkshire and Humber Deanery, UK
Anthony J Browning, MB, ChB, FRCS(Edin) is a member of the following medical societies: British Association of Urological Surgeons, Endourological Society, and European Association of Urology
Disclosure: Nothing to disclose.

Medical Editor

Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Martin I Resnick, MD †, Former Lester Persky Professor and Chair, Department of Urology, Former Professor, Department of Oncology, Case Western Reserve University School of Medicine
Martin I Resnick, MD † is a member of the following medical societies: American College of Surgeons, American Federation for Medical Research, American Institute of Ultrasound in Medicine, American Medical Association, American Society for Bone and Mineral Research, American Society for Reproductive Medicine, American Society of Andrology, American Surgical Association, American Urological Association, Association for Academic Surgery, Endocrine Society, National Kidney Foundation, Ohio Urological Society, and Pan American Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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