The most impoant clinical aspect of retroperitoneal fibrosis is that the fibrotic process frequently entraps and constricts the ureters thereby causing obstructive uropathy. Retroperitoneal fibrosis - It is a nonspecific, nonsuppurative inflammation of fibro-adipose tissue of unknown cause that produces symptoms by the gradual compression of tubular structures in retroperitoneal space. Aetiology of retroperitoneal fibrosis - About 2/3rd cases are primary idiopathic, are also known as Ormond's disease Secondary Retroperitoneal fibrosis a variety of inflammatory conditions - chronic pancreatitis, histoplasmosis, tuberculosis, or actinomycosis. drugs methysergide (most imp.) b blockers hydralazine a methyldopa Etacapone (used in the t/t of Parkinson's ds.) - malignancies (prostate, non-Hodgkin's lymphoma, sarcoma, characinoid & gastric cancer). antoimmune disorders (ankylosing spondylitis, SLE PAN etc.) Symptoms of retroperitoneal fibrosis - It is more common in men between 40-60 yrs of age Early symptoms are nonspecific and vague. These are Pain - Dull noncolicky and insidious in onset. Anorexia, nausea General malaise, diarrhea Later on, symptoms result from compression of tubular retroperitoneal structures. The major structure involved are- Ureter - Most commonly involved Aoa Inferior venacava Symptoms due to the involvement of ureter (usually b/1 involvement) Dysuria Frequency of urination Chills and fever occur with secondary infection of a hydronephrotic kidney. Hematuria can occur. Diagnosis The diagnosis of retroperitoneal fibrosis usually can be made accurately by intravenous pyelography if uremia is not present. The characteristic finding on pyelogram are Hydronephrosis with a dilated touous upper ureter. Medial detion of the ureter Extrinsic ureteral compression Note: In a retroperitoneal tumor, ureter is laterally deted while in retroperitoneal fibrosis ureter medially detes. Currently, the imaging procedure of choice is the CT scan. But if renal function is compromised contrast agents are not given and then MRI is the procedure of choice. T/T of Retroperitoneal fibrosis Coicosteroids, with or without surgery, are the mainstay of medical therapy. Surgical treatment is required in patients who present with moderate or massive hydronephrosis. It consists primarily of ureterolysis (freeing the ureter from adhesions and surrounding tissue) or ureteral stenting.. Also, know Paial or complete ureteral obstruction occurs in 75 to 85% of patients. Most common site of urethral obstruction is lower third of the ureter. Ref : Love & Bailey 25/e p1007