Severe Ureteral Endometriosis Complicated with Hydronephrosis: A Case Report

Abstract

Patient: Female, 42-year-old Final Diagnosis: Right hydronephrosis • ureteral endometriosis Symptoms: Tolerated painful cramps Medication: — Clinical Procedure: Right ureteral mass resection and right ureteral stump anastomosis Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Endometriosis is a disease characterized by endometrial tissue appearing outside the uterus, mainly involving the peritoneum and pelvic organs. Ureteral endometriosis (UE) is rare, typified by deep infiltrating endometriosis involving the ureter and can result in ureteral obstruction, proximal hydroureter, hydronephrosis, and impairment of renal function. Symptoms may be insidious and nonspecific and may lead to a prolonged disease course. We describe a patient with UE complicated by hydronephrosis. Case Report: A 42-year-old woman was admitted to the Urology Department with the incidental discovery of right hydronephrosis. After a thorough examination, she underwent right ureteral mass resection and right ureteral stump anastomosis. The pathology report indicated endometriosis. The patient was given 6 doses of gonadotropin-releasing hormone agonist immediately after surgery, followed by an intrauterine levonorgestrel-releasing system. Postoperative follow-up showed that no recurrence was observed in this year. Here, we briefly summarize the epidemiology, pathogenesis, clinical presentation, imaging, treatment, and prognosis of the disease. Conclusions: UE should be listed as one of the differential diagnoses of unexplained hydronephrosis in women of childbearing age, and those with dysmenorrhea should be cognizant of this disease. Active surgical treatment and long-term management should be carried out to obtain better prognosis.

Chronic Pelvic Puzzle: Navigating Deep Endometriosis with Renal Complications

“…Ureteral endometriosis should be considered among the potential differential diagnoses when encountering unexplained hydronephrosis in women of childbearing age. Individuals experiencing dysmenorrhea should be particularly aware of this condition [ 35 ].…”

“…Ureteral endometriosis can be intrinsic or extrinsic, with a 1:4 ratio, and the ureter is usually involved below the pelvic brim [ 33 , 34 ]. Ureterohydronephrosis is a consequence of urinary tract obstruction and can affect a single ureter, more commonly the left one [ 35 ], or both ureters, especially in patients with extensive pelvic endometriosis. Ureteral endometriosis is typically discovered in women aged 30 to 35 years [ 36 , 37 , 38 ], with a lower frequency in postmenopausal women [ 39 ].…”