1907 Hydronephrosis- Ureteral Squeezed by Deep Infiltrating Endometriosis Lesions

Abstract

Video Objective To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-to-end anastomosis of left ureter. Setting A 42-year-old female patient was diagnosed with left hydronephrosis 2 years ago, with slightly renal dysfunction. She complained secondary dysmenorrheal for 2 years, and a 3-cm ovarian cyst was also detected in the pelvis. In the past 2 years, she experienced Double-J catheterization twice, but recurrence occurred rapidly after extraction of D-J catheter. This year, the ultrasound examination showed an endometrial cyst with the size 41*40*29 mm, and left renal effusion with left upper ureteral dilatation. Pelvic CT shared the same finding. A laparoscopic removal of endometriosis lesions was presented (a 5-min video with key steps described). Interventions During the surgery, after extensive enterodialysis, a chocolate-looked cyst was exposed with the size 4*5cm, which was tightly adhered with the tissues nearby. The Dauglus Porch was completely blocked. Deep endometriotic lesion wrapped the left ureter tightly, which was hard and limited the movement of ureter. Ultrasonic knife and scissors were used to remove the D.I.E. lesions, and then a narrowed ring of ureter was observed, which was only 0.3cm in diameter, and 1cm in length. The upper part of the ureter was extremely dilated, which was about 1cm in diameter. End-to-end anastomosis was performed after segmental resection of the narrowed ureter. A Double “J” catheter was inserted via cystoscopy. Postoperative left hydronephrosis was completely relieved. Postoperative pathological diagnosis: D.I.E. of left ureter, and ovarian endometrioid cyst. The patient received GnRH-a injection post-operatively. Conclusion Patients complained refractory hydronephrosis, with endometriosis-related symptoms, like severe dysmenorrhea should be altered to the diagnosis of ureteral DIE. Multidisciplinary teamwork, precise exposure of the pelvic anatomy, and complete resection of DIE lesions would be crucial for the diagnosis and treatment of DIE.