Author: Raghid El-Khoury M.D. Head Department of Surgery CHU-NDS Head UrologyUnit CHU-NDS Head Department of Urology Holy Spirit University

Retroperitoneal fibrosis (RPF) is characterized by the development of extensive fibrosis throughout the retroperitoneum, typically centered over the anterior surface of the fourth and fifth lumbar vertebrae and resulting in entrapment and obstruction of retroperitoneal structures, notably the ureters. See the image below.

The symptoms and signs associated with RPF are nonspecific, including the following:

• Dull, poorly localized, noncolicky pain in the flank, back, scrotum, or lower abdomen [1] : Present in 92% of cases; in children, pain may be referred to the ipsilateral hip or gluteal region, resulting in resistance to hip extension [2]
• Fever
• Lower-extremity edema
• Phlebitis
• Deep venous thrombosis
• Weight loss, nausea, vomiting, anorexia, and malaise: Uncommon presentations
• Raynaud phenomenon, ureteric colic, hematuria, claudication, and urinary frequency: Rare manifestations

RPF can also be associated with Crohn disease, ulcerative colitis, and sclerosing cholangitis.
Primary management of RPF consists of open biopsy, ureterolysis, and lateral/intraperitoneal transposition or omental wrapping of the involved ureter.

Hydrodissection is a good option for a safe ureterolysis Hydrosurgery with hybrid technology

Hydrosurgery has been successfully used in medicine for many years. Tissue structures are dissected selectively and gently by waterjet. Blood vessels and nerves remain intact up to a certain pressure. Thereafter, vessels may be treated according to with their size. Waterjet elevation can also be used to create fluid cushions in the tissue and to separate anatomical layers from one another.

ADVANTAGES OF HYDROSURGERY

• Gentle on blood vessels, nerves and organs (fig. 1)
• Minimized bleeding, controlled management of bleeding
• High degree of tissue selectivity during preparation and dissection of tissue layers
• Needleless high-pressure elevation to create a fluid cushion (fig. 2)
• Good visibility at the operative site due to integrated irrigation and suction
• Saves time overall in the OR