Efficacy and complications of urinary drainage procedures in idiopathic retroperitoneal fibrosis complicated by extrinsic ureteral obstruction.

OBJECTIVE: To investigate the efficacy and complications of urinary drainage procedures in patients with idiopathic retroperitoneal fibrosis complicated by ureteral obstruction. METHODS: A retrospective study of 30 idiopathic retroperitoneal fibrosis patients involving 44 obstructed urinary units who underwent urinary drainage from January 2002 through April 2010 was carried out. Data of all diagnostic procedures, blood and urine cultures, and hospital admissions were collected and analyzed. RESULTS: In 12 of 44 (27%) cases, percutaneous nephrostomy was carried out at the first step. Attempted ureteral stenting at the first step was successful in 25 of 32 (79%) cases, of which 20 (80%) cases could be managed successfully by ureteral stenting alone throughout the study period. Successful prolonged urinary drainage with percutaneous nephrostomy alone was accomplished in 10 cases, three at the first step and seven at the second step after failed intraureteral stent insertion or after unsuccessful maintenance of urinary drainage with an intraureteral stent. A total of 21 urinary tract infection episodes occurred in 11 patients. The incidence and accumulated incidence of acute pyelonephritis was 0.062 episodes/100 person-days and 30%, respectively. The incidence and accumulated incidence of urosepsis was 0.015 episodes/100 person-days and 6.6%, respectively. The overall number of complications did not differ between external and internal urinary drainage procedures (percutaneous nephrostomy, 21% vs intraureteral stent, 17.9%; P = 0.79). CONCLUSION: Both intraureteral stent and percutaneous nephrostomy placement are a safe way to relieve urinary obstruction in idiopathic retroperitoneal fibrosis patients, and they have comparable complication rates. Over time, the need for using both management options in the same patient might be required. Hence, these techniques should be regarded as complementary.

Tuberculosis mimicking ileocecal intussusception in a 5-month-old girl.

A 5-month-old girl was diagnosed with tuberculosis, mimicking ileocecal intussusception. The mother of the patient was later diagnosed with renal tuberculosis attributable to the same (unique) Mycobacterium tuberculosis strain. Possibly, that transmission occurred by aspiration or ingestion of infected amniotic fluid or urine, which could occur before or during birth. This case illustrates that tuberculosis can mimic other common diseases and, therefore, can be a difficult diagnosis to make. Because respiratory infection was very unlikely in this case, congenital tuberculosis or postnatal infection via infected urine or breast milk should be in the differential diagnosis. In this article, we focus on different (nonrespiratory) transmission routes of Mycobacterium tuberculosis and give a short review of the recent literature on congenital tuberculosis.

Brief communication: tamoxifen therapy for nonmalignant retroperitoneal fibrosis.

BACKGROUND: Anecdotal case reports suggest tamoxifen as a possible treatment for retroperitoneal fibrosis, but a systematic assessment of its effect is not available. OBJECTIVE: To describe the course and outcomes of patients with nonmalignant retroperitoneal fibrosis treated with tamoxifen. DESIGN: Prospective, consecutive series. SETTING: Single tertiary care referral center. PATIENTS: 19 patients with nonmalignant retroperitoneal fibrosis treated with tamoxifen from April 1998 through April 2005. INTERVENTION: Tamoxifen, 20 mg orally twice daily. MEASUREMENTS: Clinical improvement, laboratory variables, and follow-up computed tomography (CT) and gallium scan findings. RESULTS: Fifteen patients reported substantial resolution of symptoms after a median treatment duration of 2.5 weeks. Erythrocyte sedimentation rate and C-reactive protein also improved. Gallium scanning at follow-up showed incomplete disappearance of pathologic gallium-67 activity. Repeated CT scanning showed slow but steady mass regression in 14 of 15 clinical responders. Five patients failed treatment, including 1 patient who improved clinically. Disease recurred in 1 patient who responded to reintroduction of tamoxifen. One patient developed reversible hepatitis. LIMITATIONS: This small observational study did not have a control group. CONCLUSION: Tamoxifen may be a viable therapeutic option in the treatment of retroperitoneal fibrosis.