Deep Infiltrating Endometriosis—Urinary Tract Involvement and Predictive Factors for Major Surgery

Freire, Maria José; Dinis, Paulo; Medeiros, Rita; Sousa, Luís; Águas, Fernanda; Figueiredo, Arnaldo

doi:10.1016/j.urology.2017.06.039

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…It is important to exclude impaired renal function when there is suspected UE. Renal function tests and urinalysis, to include infection, should be conducted in patients with flank pain or hematuria [ 53 ].…”

Section: Ureteral Endometriosismentioning

confidence: 99%

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment

et al. 2020

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We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.

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Section: Ureteral Endometriosismentioning

confidence: 99%

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment

et al. 2020

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“…The following information is based on the authors’ best interpretation of the data on ureteral outcomes. A total of 151 cases of end-to-end anastomosis for ureteral endometriosis were identified in the literature; 5–8,14–45 demographics and surgical data are summarized in Table 1. In total, 75 cases were performed by laparoscopy, 18 by laparotomy, 1 by robot-assisted laparoscopy, and in 57 cases, the route was not specified.…”

Section: Methodsmentioning

confidence: 99%

Ureteroureteral anastomosis for endometriosis involving the ureter: Case series and literature review

Goggins

Wong

Lindsey

et al. 2019

Journal of Endometriosis and Pelvic Pain Disorders

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Introduction: The purpose of this study was to review operative management of endometriosis involving the ureter. Materials and methods: Retrospective case series of three patients undergoing resection of ureteral endometriosis with ureteroureterostomy for endometriosis involving the ureter by minimally invasive gynecologic surgeons between 2007 and 2018 at a large academic medical center in the Northeastern United States. A literature review was conducted to find cases with a similar approach. Results: Three cases of ureteral endometriosis surgically managed at our institution with ureteroureteral anastomosis were identified. Ureteral endometriosis was identified preoperatively by hydroureteronephrosis on imaging. Intrinsic ureteral endometriosis was confirmed by pathology in two cases; extrinsic endometriosis was grossly visualized in one case. Operative times ranged from 300 to 387 min. Estimated blood loss ranged from 150 to 250 mL. There were no intraoperative complications. A total of 151 cases with a similar approach were described in the literature. Recurrence of obstructive uropathy occurred in 11 cases. Conclusion: Ureteral endometriosis is a rare complication with several management options. Ureterectomy with ureteroureterostomy has been described in the literature and in three cases at our institution with low complication rates and rare stricture formation. This technique can be successful in the management of ureteral endometriosis and warrants further investigation.

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“…Pathologic entities such as endometriosis, 1 fibroids, 2 and gynecologic malignancy 3 can affect the ureters, usually due to extrinsic compression, leading to hydroureter, hydronephrosis, and ultimately, loss of renal function 4‐6 . Occasionally, patients have urologic symptoms such as colicky flank pain and hematuria in the setting of gynecologic disease 7 .…”

mentioning

confidence: 99%

Ureter Visualization With Transvaginal Ultrasound

Ong

Leonardi

Espada

et al. 2020

J of Ultrasound Medicine

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Objectives-To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. Methods-We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. Results-A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. Conclusions-Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competencybased medical education model in learning US for identifying the ureters.

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Deep Infiltrating Endometriosis—Urinary Tract Involvement and Predictive Factors for Major Surgery

Cited by 12 publications

References 26 publications

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment

Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment

Ureteroureteral anastomosis for endometriosis involving the ureter: Case series and literature review

Ureter Visualization With Transvaginal Ultrasound

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