Ureteric displacement into a silicone cover as protection from an induced retroperitoneal fibrosis: a preliminary report of experiments in rats.

At present, the "therapy of choice" for patients presenting retroperitoneal fibrosis is uretrolysis with intraperitoneal transposition. This procedure, however, leaves the upper and lower part of the ureter vulnerable to recurrent fibrotic stricture since these portions still remain within the retroperitoneal space. In order to protect the ureter in its entire length from aggressive fibrosis an alloplastic cover might offer a better alternative. Following experimental induction of retroperitoneal fibrosis by phenol-mandelic acid in rats the entire ureter was displaced into a silicone envelope. Under the operating microscope the silicone sheath was closed around the renal pedicale by separate sutures of 8-0 prolene. The upper and lateral sealing of this pouch was done by continous sutres and the lower opening of this silicone envelope was fixed to the bladder wall. Progressive retroperitoneal fibrosis caused anterior displacement of the silicone pouch but neither a fibrotic infiltration into this coner nor ureteral stenosis was noted. Histological investigation of these animals in comparison with the control group showed effective protection by the silicone cover. Long-term results of experiments in larger animals well show whether thie procedure might be applied clinically.