Management of ureteral endometriosis: A report of ten cases

Abstract

Ureteral endometriosis is a rare entity. The upper urinary tract should be evaluated in patients with severe endometriosis, even in postmenopausal women. The treatment of ureteral endometriosis usually requires surgery, while ureterolysis should not be performed in patients with extensive disease. As a form of adjuvant therapy of surgery, hormonal therapy is an appropriate option.

Abdominopelvic Complications of Endometriosis

“…Ureteral endometriosis is a rare but serious localization of the disease (<0.3%) (Li et al, 2008) because it may cause silent loss for renal function (Abrao et al, 2009;Li et al, 2008;Mereu et al, 2010). Disease is predominantly unilateral, with the left ureter affected more commonly than the right, although bilateral disease does occur (Li et al, 2008).…”

“…Disease is predominantly unilateral, with the left ureter affected more commonly than the right, although bilateral disease does occur (Li et al, 2008). The lesions are localized in the lower third of the ureter (Abrao et al, 2009), and associated with endometriosis elsewhere in the pelvis (Li et al, 2008;Mereu et al, 2010). There are two major pathologic types of ureteral endometriosis: intrinsic and extrinsic, occurring, respectively with a 1:4 ratio.…”

“…These pathologic types can coexist. Indeed, both entities can lead to ureteral obstruction with subsequent hydroureter and dilatation of the renal pelvis that can be also asymptomatic (Li et al, 2008). Generally, bladder is not affected for endometriosis in the patients with ureteral endometriosis.…”

“…Because of the absence urologic symptoms (56.5%) and the risk for subsequent loss of renal function (20%), checking the integrity of the urinary tract of patients with endometriosis not only before surgery and after surgery but also during medical therapy is recommended (Li et al, 2008;Mereu et al, 2010). Rectal or vaginal infiltration by the posterior DIE is present in 74% of these patients, and extensiveness of adnexal adhesion are factors related to dysmenorrhea severity (Abrao et al, 2009).…”

“…Patients with renal compromise may benefit from percutaneous nephrostomy for urinary diversion before definitive surgery. The pelvic spread of the disease and its involvement of the other pelvic organs are evaluated by CT and/or MRI (Li et al, 2008).…”