Original articleLaparoscopic management of ureteral endometriosis: Our experience
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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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.