Female UrologyPrevalence and Management of Urinary Tract Endometriosis: A Clinical Case Series
Section snippets
Patients
Two-hundred twenty-one consecutive patients who underwent laparoscopic surgery for severe (deep infiltrating) pelvic endometriosis in our referral center between July 2007 and February 2010 were eligible for this retrospective case series. The inclusion criterion was presence of UTE (bladder and/or ureteral endometriosis). The indication for surgery was presence of a symptomatic and severe endometriosis with or without a desire to become pregnant in the future. The diagnosis was made by
Results
The prevalence of UTE was 19.5% in our cohort (n = 43/221). Patients' mean age was 32.3 years (range 24-48). The mean hospital stay was 5.6 days in patients with UTE vs 4.3 days in patients without UTE (P = .001). Patient characteristics are presented in Table 1. In detail, bladder and ureteral endometriosis were found in 30 (13.6%) and 10 (4.5%) patients, respectively. Three patients (1.4%) had both bladder and ureteral involvement. Representative pictures are shown in Figure 1. Our analysis
Comment
The preoperative diagnosis of UTE is difficult and requires great vigilance. It is increasingly recognized the greater the awareness of it. However, on clinical examination and laparoscopic inspection, UTE can be easily missed. Although rare, ureteral endometriosis can cause significant morbidity, such as a silent kidney or progressive renal function loss. Because of delayed diagnosis, the ureteral lumen can progressively narrow, with a consequent worsening of hydronephrosis.
Specific symptoms
Conclusions
In severe pelvic endometriosis, involvement of the urinary tract is quite common. The laparoscopic approach is feasible and appears to be safe. Ureteral endometriosis is often asymptomatic, but should always be kept in mind when the uterosacral ligaments are infiltrated clinically. A preoperative pelvic MRI can be very useful to appreciate the whole extent of the disease.
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