Retroperitoneal fibrosis ( Ormond 's disease) - Causes, Symptoms and Treatment .MF .
retroperitoneal fibrosis (retroperitoneal fibrosis, Ormond's disease) - a chronic inflammation of the adipose tissue of the retroperitoneal space, which gradually leads to compression and impaired patency of tubular structures of the anatomic site.Most often, as these tubular structures are the ureters.
reasons retroperitoneal fibrosis
There are two theories of Ormond's disease.The first is based on inflammation, while the second - on the immune reactions.Also, in some medical sources Ormond's disease belongs to a group of true connective tissue, that is, systemic connective tissue diseases.
There are many factors which, according to experts, can lead to the appearance of retroperitoneal fibrosis.These include malignant tumors, chronic pancreatitis, chronic hepatitis, tuberculosis lesion of the spine, radiation exposure, large hematoma of the lumbar region, the effects of toxic drugs and chemicals.Despite such a large range of risk factors, many of Ormond's disease patients can not identify any.Then
mechanism of pathology due to the fact that under the influence of these factors occurs sclerosis fat retroperitoneal space, resulting in a mechanically compressed vessels that are there, and the ureter.This leads to hydronephrosis or pyelonephritis, and eventually, to kidney and wrinkled.Furthermore, the clinical picture may be intestinal obstruction due to compression fat colon.
retroperitoneal fibrosis Symptoms depend on the stage and extent of the pathological process activity.Academically course of the disease is divided into three stages: the debut of the disease, the period of activity and the period of the fibrous mass reduction.
In the first stage, patients complain of persistent dull pain in the lumbar region, starting at one end and gradually spread to the second.At the same time, the pain may be given in the region of the back, abdomen and external genitalia.At this point it can also mark a slight increase in blood pressure and symptoms of general fatigue: fatigue, headache, sweating.About aunts patients with pathology Ormond at this point note the presence of tumor formation in the pelvis or abdomen.
The second and third stages of the disease is the slow progress of the symptoms.Together with increased pain in patients with marked decrease in the amount of urine, up to complete anuria (absence of urine).If the disease is unilateral nature, the second kidney compensates for the lack of the patient.When two-way Ormond's disease, the protein products of metabolism that are not excreted in the urine, into the blood.This results in a septic state, called uremia.Such patients need immediate connect an artificial kidney machine.Otherwise, the disease ends lethally.
Together with symptoms from the kidney starts to progress hypertension, which develops as a result of pressure on the renal artery.Patients complain of constant improvement in blood pressure, which is manifested by headaches, especially in the neck.
typical sign of retroperitoneal fibrosis is venous hypertension, which occurs due to compression of the inferior vena cava.The symptoms of the disease state is varicose veins and the veins of the testicles in men.As a complication of blood stagnation in the lower half of the body can cause thrombosis of the inferior vena cava, which, however, is quite rare.
the presence of at least one of the above symptoms, you should immediately consulting a urologist because of the disease Ormond has a rule that the sooner treatment is started, so it's best to be its results.
diagnosis disease Ormond
the early stages of retroperitoneal fibrosis markers of the disease can be extremely laboratory blood parameters.Determined erythrocyte sedimentation rate, which is usually increased, and inflammatory markers such as C-reactive protein and alpha-globulins.
In the second stage of the disease is used to verify the diagnosis excretory urography.The picture shows the expansion of the renal pelvis is determined by and changes in the contour of the ureter.Moreover, when we look at the picture you can see that there is a distortion of the ureter due to external compression.
excretory urography - narrowing of the ureter
Among other methods of research is to provide a computer tomography and ultrasound.As in the first and in the second case it is possible to identify seal retroperitoneal fat.
The only reliable method of verification of the diagnosis of the disease Ormond is a biopsy of the lumbar region.In histological sections can be revealed increased production of fibrin fibers in the adipose tissue.
also in bright clinical symptoms of the cardiovascular or digestive system held irigografiya (contrast study of the colon) and contrast aortography.The latter makes it possible to determine the functional and anatomical condition of the renal arteries.
Treatment of retroperitoneal fibrosis
Conservative treatment of Ormond's disease is used only when the patient is asymptomatic ureteral compression, intestines and blood vessels.The purpose of the application is the process progresses warning.For conservative treatment retroperitoneal fibrosis usually applied hormones and non-steroidal anti-inflammatory agents.Well proven collaborative application circuit prednisone and celecoxib.These drugs can be purchased without a prescription, but do it categorically impossible, given the large number of side effects.
In the absence of effect of conservative treatment or if the patient's symptoms of compression of tubular structures, the patient is recommended surgery.The operation is carved fibrotic adipose tissue and restoration of the lumen as the ureter, and blood vessels.Quite often it happens that for the restoration of the normal passage of urine or blood flow has to make plastic ureteral or vascular tissues of the body.
In advanced stages, when the clearance is completely overlaps both ureters and you can not hold the plastic last, the operation is performed to impose nephrostomy, the essence of which is to move in the anterior abdominal wall of the tube through which urine leaves in a special tank.
Laparoscopic surgery for disease Ormond
Treatment folk remedies
Treatment of retroperitoneal fibrosis folk remedies, usually involves the use of compresses.Used lotions of infusions sets of herbs and plants.It should be noted that in some cases the use of this treatment may produce temporary results and pause bit fibrosis.On the one hand it may seem a good practice, although representatives of traditional medicine is not recommended to get involved in them.The fact is that getting even minimal relief to patients begin to abuse people's treatment methods, forgetting about the traditional.In the end, this leads to the inevitable progress of the disease and its transition to the severe forms of treatment which is only possible by surgery.Urologists recommend the use of packs in combination with drug therapy, which gives more reliable results, although not completely cure the disease.
Feeding habits and lifestyle with the disease Ormond
patients with retroperitoneal fibrosis is recommended to adhere to a strict diet with the exception of the fried, salty, sour and smoked products.This is especially important in the early stages of the disease, when the first place a task to prevent the progression of the pathological process.If the patient already has symptoms of narrowing of the ureter, it must recommend drinking plenty of fluids, to the constant circulation of urine made it impossible to progress the disease.
special way of life of the patient can only be changed if it has nephrostomy after surgery.Such patients should be taught to use the urinal, in order to avoid any maceration (soak) the skin around the nephrostomy tube.
Complications retroperitoneal fibrosis
The first and most serious complication of the disease Ormond - anuria it with the subsequent development of chronic renal failure.It occurs due to constant stagnation of urine in the kidney pelvis system and the destruction of its cells.
Another serious complication of retroperitoneal fibrosis is hypertension, which occurs due to narrowing of the renal artery and compensatory renin release a large number, which is a powerful hypertensive agent.
narrowing of the lumen of the inferior vena cava can threaten the patient development of varicose veins.It manifests an increase in the lumen of the lower limbs and the soreness in their area.With strong expansion can develop even sores that have a very bad tendency to healing.
Compression colon lumen can contribute to the development of chronic intestinal obstruction, manifested prolonged constipation, flatus and bowel distention.In advanced forms it can lead to the development of intestinal intoxication.
Prevention retroperitoneal fibrosis
Prevention Ormond disease primarily is to eliminate the factors that may contribute to its development.If the patient has chronic pancreatitis, hepatitis, tuberculosis and systemic vascular disease, in the first place, it is necessary to do their treatment.
Then the state should be closely monitored their health, not to miss the development of the first clinical symptoms.It must be remembered that if the early detection of Ormond's disease, the hormone therapy forces one can avoid surgery.
Ed.urologist Astashin EE