Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases

Kunlin Yang,Aobing Mei,Ye Lu,Sida Cheng,Yukun Cai,Jiankun Qiao,Shengwei Xiong,Xuesong Li,Liqun Zhou,Xinfei Li,Yangyang Xu

doi:10.1186/s12905-021-01349-7

Abstract

BackgroundTo present the experience with the surgical management of ureteral endometriosis (UE) in our single center.MethodsTo present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed.ResultsForty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively.Conclusions Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.

Highlights

To present the experience with the surgical management of ureteral endometriosis (UE) in our single center
The literature reports that the incidence of urinary tract endometriosis (UTE) ranges from 0.3 to 12% among all women affected by endometriosis [3]
The late diagnosis and treatment of UE might lead to a silent loss of renal function

Summary

Introduction

To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. Endometriosis is a common gynecologic disorder in women of childbearing age, with a prevalence of 10–20% among the general female population [1]. Yang et al BMC Women’s Health (2021) 21:206 of women with endometriosis may be asymptomatic [2]. The literature reports that the incidence of UTE ranges from 0.3 to 12% among all women affected by endometriosis [3]. Ureteral endometriosis (UE) is a relatively rare situation and is the second most common type of UTE after bladder endometriosis [4]. In a study reported by Jadoul P et al, the risk of loss of renal function among patients with UE was 11.5% [6, 7]

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Discussion

Conclusion