Laparoscopy for ureteral endometriosis: surgical details, long-term follow-up, and fertility outcomes

Uccella, Stefano; Cromi, Antonella; Casarin, Jvan; Bogani, Giorgio; Pinelli, Ciro; Serati, Maurizio; Ghezzi, Fabio

doi:10.1016/j.fertnstert.2014.03.055

Cited by 69 publications

(79 citation statements)

References 26 publications

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“…A similar rate has been reported in previous studies, in which many concomitant procedures have also been performed [5, 6, 34] but there are also reports where all or almost all urinary tract operations have been performed laparoscopically [3, 7, 10, 32, 37, 38]. All our isolated bladder resections and associated ureteral shavings were done laparoscopically as in many other series [10, 35, 39, 40] but with increasing amount of concomitant procedures also the proportion of laparotomies increased. Further, in contrast to some other studies [24, 41–43], none of the UNCs were performed via laparoscopy in our series as our urologist are not yet so familiar with advanced laparoscopy.…”

Section: Discussionsupporting

confidence: 84%

“…The long-term follow-up was 5.1 years and two women were lost after moving elsewhere. The recurrence rate of UTE following surgery was 4 %, which is comparable with that in previous studies [6, 10, 33–35]. Thus, it has been suggested that recurrences are less common after surgery for UTE than for other forms of endometriosis [10].…”

Section: Discussionsupporting

confidence: 83%

“…Nine out of 10 patients suffered from dysmenorrhea and more than half suffered from symptoms suggestive of UTE. As in other studies [7, 10, 31–35], almost half of our patients had a history of previous endometriosis surgery. This might indicate that the delay in reaching the correct diagnosis and getting to the referral center is long.…”

Section: Discussionsupporting

confidence: 55%

“…It is controversial what kind of operation is needed in case of hydronephroses and diminished renal function [3]. Large endometriotic nodule and severe hydronephrosis are risk factors for adverse outcome and might be indications for ureteral resection [35]. In our study, UNC was chosen as endometriotic lesions were large, situated near the bladder wall, or caused hydronephrosis but most of the lesions were extrinsic by histology.…”

Section: Discussionmentioning

confidence: 99%

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Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

et al. 2016

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Urinary tract endometriosis (UTE) is a rare form of deep infiltrating endometriosis. We studied the operative treatment of UTE and evaluated postoperative recurrences and fertility outcomes. This is a retrospective cohort study of 53 women who underwent operative treatment for UTE in 2004–2013 at Helsinki University Hospital, and were followed-up until the end of 2014. The data were gathered from the hospital’s electronic database. The main outcome measures were complications, reoperations, postoperative pregnancies, and deliveries. Preoperative diagnosis was accurate in 72 % with bladder endometriosis and in 93 % with ureteral disease. Thirty-one (58 %) of the 53 operations were performed via laparoscopy. Postoperative complications requiring re-intervention occurred in five cases (9 %). Five reoperations were performed in four cases due to endometriosis recurrence, only two due to recurrence of UTE (4 %). Twenty-eight women wished for pregnancy; 18 (64 %) of them conceived. Infertility treatment was needed in 20 (71 %) cases. Twelve (75 %) women delivered via cesarean section; intraoperative difficulties occurred in ten (83 %). The complication rate with UTE operations is acceptable and recurrences are rare. Infertility is common, but 57 % of those who wished for a child succeeded. A majority of the deliveries involved unplanned and complicated cesarean section.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

et al. 2016

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“…bowel or kidneys) [3,4,[12][13][14][15]. Surgery is also recommended 69 in cases of severe pain that is refractory to drug treatment [16,17].…”

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confidence: 99%

Validation of a score to guide endometriosis therapy for the non‐specialized gynecologist

Lasmar

Lasmar²,

Celeste

et al. 2015

Intl J Gynecology & Obste

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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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Laparoscopy for ureteral endometriosis: surgical details, long-term follow-up, and fertility outcomes

Cited by 69 publications

References 26 publications

Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

Validation of a score to guide endometriosis therapy for the non‐specialized gynecologist

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

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