Silent Retroperitoneal Fibrosis Associated With Methysergide Therapy

Intravenous urography was performed in 114 asymptomatic patients who had been treated with methysergide maleate for six months or longer. There were 13 abnormal urograms; 5 revealed congenital anomalies, and 5 showed medial deviation of the ureter but no other abnormalities. In three there was the characteristic picture of retroperitoneal fibrosis; two of these showed marked roentgenographic improvement after methysergide therapy was stopped, while in the third there was only partial improvement. Withdrawal of methysergide did not affect the medial deviation of the ureter. We recommend that a urogram be obtained at the start of methysergide therapy, and that urography be repeated at six-month intervals during therapy. Early recognition of silent ureteral obstruction may prevent renal damage, since the fibrosis usually regresses with drug withdrawal.