Retroperitoneal fibrosis is a rare disorder in which fibrous tissue proliferates in the retroperitoneal space, gradually encasing the abdominal aorta, ureters, and adjacent structures. Onset is insidious and early complaints are non-specific, so diagnosis is often delayed.
- Dull, persistent pain
Deep, aching discomfort is the most frequent first symptom. Pain is usually felt in the flank, lower back, or iliac fossa, may radiate to the groin or anterior thigh, and is characteristically unrelieved by rest or change of posture; NSAIDs give only temporary relief. - Constitutional symptoms
Low-grade fever, fatigue, anorexia, weight loss, and general malaise accompany the inflammatory phase in more than half of patients. - Urinary manifestations
Encasement of the ureters leads to obstructive uropathy: flank colic, frequency, urgency, oliguria, or anuria. Painless bilateral hydronephrosis is common and, if untreated, may progress to azotaemia and renal failure. - Genital-oedematous signs
Males often note testicular or scrotal pain, hydrocele, or varicocele, while compression of iliac veins can produce unilateral or bilateral leg oedema, superficial thrombophlebitis, or even deep-vein thrombosis. - Vascular sequelae
Involvement of the aortic wall or renal arteries may cause renovascular hypertension; lower-limb claudication or intestinal angina appear when iliac or mesenteric vessels are narrowed. - Gastro-intestinal upset
Constipation, vague abdominal fullness, or, less often, sub-occlusive episodes occur if duodenal or mesenteric encasement develops. Rarely, bile-duct compression presents as obstructive jaundice.
Because findings are initially subtle, any combination of unexplained back/flank pain, constitutional decline, and urinary or oedematous changes should raise suspicion and prompt imaging to prevent irreversible renal damage.
| Key Symptom / Sign | Typical Features |
|---|---|
| Pain | Dull, deep, flank/back → groin/thigh; nocturnal accentuation |
| Constitutional | Low-grade fever, fatigue, weight loss, anorexia |
| Urinary obstruction | Colic, frequency, oliguria, bilateral hydronephrosis |
| Genital / limb oedema | Testicular pain, hydrocele, leg swelling, thrombophlebitis |
| Vascular compromise | New hypertension, claudication, intestinal ischaemia |
| Gastro-intestinal | Constipation, sub-occlusion, rarely obstructive jaundice |