Original article
Laparoscopic management of ureteral endometriosis: Our experience

https://doi.org/10.1016/j.jmig.2006.09.009Get rights and content

Abstract

Study objective

Ureteral endometriosis is rare, accounting for less than 0.3% of all endometriotic lesions. The aim of our study is to evaluate the prevalence of extrinsic ureteral endometriosis in women undergoing laparoscopic surgery for severe endometriosis and to suggest that laparoscopic ureterolysis represents a mandatory measure in all cases to avoid ureteral injury.

Methods

A retrospective analysis was performed of all cases of patients who underwent laparoscopic surgery for severe endometriosis at the departments of obstetrics and gynecology at CMCO-SIHCUS and Hautepierre Hospital, Strasbourg, from November 2004 through January 2006.

Measurements and main results

We recorded 54 patients with a mean age of 31 years and a mean body mass index of 21.9. Reported symptoms were dysmenorrhea (88%), severe dyspareunia (88%), severe pelvic pain (38.8%), and infertility (74%). Five women presented with dysuria, frequency, recurrent urinary tract infections, and pain in the renal angle, and 2 patients had hydronephrosis. We observed 3 patients (5.6%) with ureteral stenosis, 35 (64.8%) with adenomyotic tissue surrounding the ureter without stenosis, and 16 (29.6%) with adenomyotic tissue adjacent to the ureter. It was on the left side in 47.4% of cases, on the right side in 31.6% cases, and bilaterally in 21% of cases. In 9 patients, ureteral involvement was associated with bladder endometriosis (16.7%). In all patients, ureterolysis was performed. There was 1 case of ureteral injury during the procedure, 2 of transitory urinary retention, and 1 of uretero-vaginal fistula after surgery. During the first year of follow-up, the disease recurred in 4 patients, with no evidence of the disease in the urinary tract.

Conclusion

Conservative laparoscopic surgery to relieve ureteral obstruction and remove pathologic tissue is the management of choice. Resection of part of the ureter should be performed only in exceptional cases. Ureterolysis should be performed in all patients before endometriotic nodule resection to recognize and prevent any ureteral damage.

Section snippets

Material and methods

A retrospective descriptive study was performed to evaluate the patients who underwent laparoscopic surgery for severe endometriosis from November 2004 through January 2006 at the Department of Obstetrics and Gynecology, CMCO-SIHCUS and Hautepierre Hospitals, Strasbourg, France.

Baseline data were acquired through a systematic review of hospital inpatient and office outpatient charts with a specially designed data collection form. Evaluated data were age, body mass index, fertility, symptoms,

Results

Fifty-four patients were included in this study, all of whom underwent laparoscopic surgery for deep infiltrating endometriosis. The mean age was 31 years (range age 23–44 years, STD: 4.7) with a mean body mass index of 21.9 (range 17–35). Reported symptoms were dysmenorrhea (88%), dyspareunia (88%), severe pelvic pain (38.8%), and infertility (74%). Five women had nonspecific urinary symptoms such as dysuria, frequency, recurrent urinary tract infections, and pain in the renal angle; 2

Discussion

Ureteral endometriosis is rare, accounting for less than 0.3% of all endometriotic lesions. The first case of endometriosis causing obstructive uropathy was described by Cullen8 in 1917. In our study, we found 5.5% of ureteral stenosis in 54 patients with severe endometriosis.

Usually extrinsic involvement is more frequent than intrinsic.3 This was confirmed in our series because we found only cases of external ureteral endometriosis, and we didn’t find any cases of intrinsic ureteral

Conclusion

Surgical treatment remains the gold standard in severe forms of endometriosis. Conservative surgery to relieve ureteral obstruction and remove pathologic tissue is the management of choice, and we believe that operative laparoscopy is the best approach. We believe that laparoscopic surgery provides the surgeon with a magnified view, superior exposure, and greater ability to identify the disease in the pelvis and retroperitoneal space and also in the lower urinary tract. According to our

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