IDIOPATHIC RETROPERITONEAL FIBROSIS:Notes on its Diagnosis, Management and Pathogenesis ¹

SUMMARY This report is based on five cases of idiopathic retroperitoneal fibrosis treated at St Thomas's Hospital, London. Three cases are described in detail. The need for diagnostic awareness when investigating backache and disturbances of urine output is emphasised. The usefulness of the E.S.R. and retrograde ureterogram in making the diagnosis is illustrated. The Photographic Department of St Thomas's Hospital has provided the illustrations. The operative procedures used in management are discussed, preference being given to extended ureterolysis with lateral displacement of the ureters to prevent their subsequent recurrent involvement. Intraluminal ureteral pressure recordings are presented in support of the hypothesis that the ureteral obstruction in retroperitoneal fibrosis is functional in nature. I wish to thank the staff of the Department of Urology, St Thomas's Hospital, London, and in particular Mr Kenneth Shuttleworth under whose care these patients were, for permission to publish this paper. Thanks are also due to Mr Martin Claridge and Mr Adrian Marston, who carried out some of the surgery described.