T

FIGURE 8-50 (Continued)

FIGURE 8-50 (Continued)

often to reduce the bulk of the tumor and relieve the ureteral obstruction. Administration of corticosteroids, however, should be considered only when malignancy and retroperitoneal infection can be ruled out. As in other chronic renal diseases, administration of corticosteroids should be kept at the minimal level capable of controlling symptoms. Surgical ureterolysis, which consists of freeing the ureters from the fibrotic mass, lateralizing them, and wrapping them in omentum to prevent repeat obstruction, is often necessary. Other immunosuppressive agents have been used rarely when the systemic manifestations of the disease cannot be controlled with safe doses of corticosteroids. In most cases the long-term outcome of idiopathic retroperitoneal fibrosis is satisfactory [75-77].

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