Simultaneous bilateral subcutaneous pyelovesical bypass as a salvage procedure in refractory retroperitoneal fibrosis

Abstract

Ureteral obstruction causing renal failure is the most common complication associated with retroperitoneal fibrosis (RPF). Initial management includes steroid therapy together with ureteral stenting. When these fail, ureterolysis is the recommended surgical procedure. However, this could be challenging and recurrence is common. The aim of the present case series was to assess the feasibility of inserting simultaneous bilateral subcutaneous pyelovesical bypass grafts (SPBGs) in patients presenting with RPF who had failed initial endourologic/surgical management.

Fig. 1.

A computed tomography scan taken at the 14-month follow-up revealed bilateral resolution of hydronephrosis in the presence of a persistent retroperitoneal mass encasing the aorta and inferior vena cava. The subcutaneous pyelovesical bypass grafts remain properly positioned as the radiopaque mark of the prosthesis can be found between the renal parenchyma and calyx bilaterally.

Fig. 2.

A 3D-reconstruction using computed tomography-derived images shows bilateral subcutaneous pyelovesical bypass graft implants.