Management of ureteral endometriosis with hydronephrosis: Experience from a tertiary medical center

Abstract

Hydronephrosis may be caused by uncommon reasons, such as ureteral endometriosis, which can even cause silent loss of renal function. Routine ultrasound scanning of the upper urinary tract for severe stages of endometriosis is very important in order to detect any potential ureteral lesions. Ureterolysis should be considered as the first surgical step, not only to avoid iatrogenic ureteral injuries but also to better evaluate ureter involvement for further procedures. To warrant tension-free and lesion-free anastomosis, it is wise to perform ureteroneocystostomy for long-term sound results.

Retroperitoneal Endometrioid Carcinoma Arising from Ureteral Endometriosis

“…It is mainly found incidentally during laparoscopy for extensive endometriosis [3]. The symptoms are usually non-specific, such as dysmenorrhea, dyspareunia and non-menstrual pelvic pain, and owing to secondary obstruction [4, 5]. The diagnosis of UE is difficult since the disease may be clinically silent in up to 30% of patients.…”

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

“…34 Intrinsic ureteral endometriosis is associated with a greater degree of hydronephrosis compared to extrinsic disease. 23 Several screening modalities have been suggested including IVP, ultrasound, CT, and MRI. MRI has been discussed as the preferred method due to the ability to visualize all components of the urinary system and examine sites of possible pelvic endometriosis.…”

“…Characteristics of women at higher risk have been described including those with rectovaginal septum endometriosis, larger uterosacral ligament nodules, severe pelvic disease, and older age. 2,5,6,19,23,47,48 Ureteral compression has been found to be present in 60% of women with ureteral endometriosis and is associated with lower body mass index and parametrial endometriosis. 34 Intrinsic ureteral endometriosis is associated with a greater degree of hydronephrosis compared to extrinsic disease.…”

“…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.…”

“…An additional recurrence of hydronephrosis 6 months postoperatively failed stent placement and required left nephrectomy. 23 There were five total cases of recurrent obstructive uropathy managed by ureteroneocystostomy 6,20,26,29 with the addition of salpingo-oophorectomy and danazol therapy in one of these cases. 26 Alves et al reported four episodes of recurrence among 21 patients treated by ureteral reanastomosis.…”