Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series

Seracchioli, Renato; Raimondo, Diego; Donato, Nadine Di; Leonardi, Deborah; Spagnolo, Emanuela; Paradisi, Roberto; Montanari, Giulia; Caprara, Giacomo; Zannoni, Letizia

doi:10.1093/humrep/deu360

Cited by 40 publications

(42 citation statements)

References 33 publications

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“…Bladder endometriosis is often multifocal, the trigone and the dome being the most frequently affected sites [ 15 ]. The distal ureter, 3–4 cm above the vesico-ureteral junction, is the most common ureteral segment involved [ 14 , 30 ].…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

“…All patients with urinary tract endometriosis should be assessed for renal function by blood creatinine measurements, since when endometriosis involves the ureters a silent loss of renal function may occur [ 15 , 29 ]. Ureteral endometriosis is most often unilateral, with a left predisposition; bilateral involvement is present in approximately 10–20% of cases [ 30 ]. Ureteral involvement is often associated with an ipsilateral endometrioma or with a recto-vaginal nodule larger than 3 cm [ 29 , 30 ].…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

“…Ureteral endometriosis is most often unilateral, with a left predisposition; bilateral involvement is present in approximately 10–20% of cases [ 30 ]. Ureteral involvement is often associated with an ipsilateral endometrioma or with a recto-vaginal nodule larger than 3 cm [ 29 , 30 ]. Even if ureteral endometriosis is now increasingly recognized because of the improvement in diagnostic tools [ 35 ], preoperative diagnosis is challenging mostly when it is not complicated by obstruction and proximal dilatation [ 36 ].…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

“…In a retrospective series including 77 patients affected by ureteral endometriosis Seracchioli et al [ 30 ] described two different histological pattern of ureteral involvement: endometriotic ureteral endometriosis characterized by endometrial glands and/or stroma cells within the wall of the ureter or within periureteral tissue, and fibrotic ureteral endometriosis where only fibrosis tissue was observed. They found that the endometriotic pattern (77% of patients) was significantly associated with hydroureteronephrosis at pre-operative uro-CT scan, whereas the fibrotic pattern (23% of patients) was significantly associated with concomitant endometriosis in the recto-vaginal septum.…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

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Endometriosis: clinical features, MR imaging findings and pathologic correlation

et al. 2018

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ObjectiveWe illustrate the magnetic resonance imaging (MRI) features of endometriosis.BackgroundEndometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation.ConclusionOwing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work.Teaching Points • Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis. • MRI is a second-line imaging technique after US. • Deep pelvic endometriosis is associated with chronic pelvic pain and infertility. • Endometriosis is characterized by considerable diagnostic delay. • MRI is the best imaging technique for preoperative staging of endometriosis.

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Section: Mr Imaging Findingsmentioning

confidence: 99%

Section: Mr Imaging Findingsmentioning

confidence: 99%

Section: Mr Imaging Findingsmentioning

confidence: 99%

Section: Mr Imaging Findingsmentioning

confidence: 99%

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Endometriosis: clinical features, MR imaging findings and pathologic correlation

et al. 2018

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“…Ureteral endometriosis occurs in just 15% of cases. Ureteral involvement usually occurs near its insertion in the bladder, just above the ureterovesical junction (UVJ), near where it crosses the uterine artery [1][2][3][4][5][6]. We believe that this prevalence is underestimated due to the scarce data in the literature and the lack of standardization of the surgical technique around the world in different countries.…”

Section: Introductionmentioning

confidence: 99%

New Paradigms in Endometriosis Surgery of the Distal Ureter

Júnior¹,

Vieiralves²,

Buere³

et al. 2018

Recent Advances in Laparoscopic Surgery [Working Title]

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It is estimated that 2% of endometriosis cases involve the urinary tract and that the ureter is involved in up to 30% of these cases, or 0.6% of all endometriosis cases. Increasingly, the standardization and systematization of surgical treatment of endometriosis require the surgeon to have knowledge of the surgical spaces and the ureteral and surrounding pelvic anatomy in order to carry out a cytoreductive surgery that is as possible. A thorough workup is essential for the differentiation of intrinsic or extrinsic endometriosis of the ureter. The use of the resonance imaging preoperatively and ureteroscopy intraoperatively is now considered indispensable. The decision and choice of the best technique will be guided by the diagnosis (intrinsic or extrinsic), the location of the lesions, the length of the involved segment (greater or less than 3 cm), vitality of the ureter stumps, and anastomosis without tension. The main alternatives are ureterolysis and dilatation with balloon catheter which is performed for extrinsic endometriosis more than 85% of the time and ureterectomy for intrinsic endometriosis. To perform the reconstruction, the techniques with end-to-end anastomosis with the distal ureter stump or ureterovesical reimplantation are used. Increasingly, with better knowledge of the distal ureter anatomy, easier access through laparoscopy and in contradiction to the current recommendations, we are verifying that the end-to-end anastomosis has become the preferred option or procedure of choice for ureteral reconstruction, with ureterovesical reimplantation the second option.

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Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: Is it useful?

Borghese

Raimondo

Esposti

et al. 2021

Intl J Gynecology & Obste

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Objective Systematic placement of a ureteral stent before surgery for posterior deep infiltrating endometriosis (DIE) was previously recommended, but it could increase perioperative complications. We evaluate the role of preoperative ureteral stent in women requiring surgery for ureteral involvement (UI) with large posterior DIE nodules and/or grade I–II hydronephrosis. Methods Women undergoing minimally invasive surgery for DIE with UI having posterior nodules >3 cm and/or grade I–II hydronephrosis from 2014 to 2019 were retrospectively included. We progressively changed our strategy from a systematic pre‐operative stent insertion (S‐PS, up to 2016) to a non‐systematic one (NS‐PS, from 2016). Results Eighty‐eight women in the S‐PS group and 96 in the NS‐PS were included. Low urinary tract infections (UTI) were higher in the S‐PS group (13.6% vs 2.1%, P = 0.003). Hospital stay was longer in women with S‐PS (9.8 ± 5.3 days vs 6.7 ± 2.5 days, P < 0.001). Logistic regression analysis confirmed a significant association between NS‐PS and low UTI (adjusted OR 0.20, 95% CI 0.05–0.81, P = 0.024). Conclusion Systematic placement of a ureteral stent before surgery in women requiring surgery does not reduce overall perioperative complication rate, but it is associated with a longer duration of hospitalization and a higher low UTI rate.

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Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series

Abstract: None.

Cited by 40 publications

References 33 publications

Endometriosis: clinical features, MR imaging findings and pathologic correlation

Endometriosis: clinical features, MR imaging findings and pathologic correlation

New Paradigms in Endometriosis Surgery of the Distal Ureter

Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: Is it useful?

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