Abstract
To investigate the short-term outcomes of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis (UE). Retrospective cohort study of consecutive patients who underwent surgery for the ureter endometriosis with hydronephrosis. A private hospital that provide primary, secondary and tertiary care. 30 consecutive patients with UE who underwent laparoscopic ureteroneocystostomy at our institution between May 2008 and April 2020. Laparoscopic ureteroneocystostomy, if necessary, hysterectomy, salpingo-oophorectomy, cystectomy, partial bladder resection, or partial bowel resection were performed. The most common chief complaint was pelvic pain (40%). Endometriosis affected only the left ureter in 56.7% of patients, only the right ureter in 33.3%, and both ureters in 6.7%. Involvement of the ipsilateral ovary was confirmed in 64.3%. The most frequent location of UE was 1-3cm above the UVJ (46.7%). A psoas hitch was performed in 7 patients (23.3%), and the Boari flap was used in 9 patients (30%). Hysterectomy was performed in 12 patients (40%), and 6 of them had a concomitant bilateral salpingo-oophorectomy (20%). In addition, 3 patients (10%) underwent partial bowel resection, and 2 patients (6.7%) underwent partial bladder resection. After surgery, 24 of 27 patients (80.0%) were free of sever hydronephrosis after surgery. Hydronephrosis recurred in a single patient (3.3%), but the grade of hydronephrosis improved significantly after surgery (P < 0.001). At 6months of follow up, 4 patients (13.3%) experienced urinary tract infections and 2 patients (6.7%) reported dysuria. Patients reported a regression of dysmenorrhea symptoms (P < 0.001). This study shows that ureteroneocystostomy provides good results in terms of relapses and symptom control in patients with ureteral endometriosis.
Highlights
Endometriosis, defined as the presence of endometrial glands and stroma outside the uterus [1], has an estimated prevalence of 5–15% in women of reproductive age [2]
This study shows that ureteroneocystostomy provides good results in terms of relapses and symptoms’ control in patients with ureteral endometriosis
Dysmenorrhea is extremely common in patients with Ureteral endometriosis (UE), reported by 70.6%, while 52.3% report pelvic pain [6]
Summary
Endometriosis, defined as the presence of endometrial glands and stroma outside the uterus [1], has an estimated prevalence of 5–15% in women of reproductive age [2]. Urinary tract involvement occurs in 1% of affected women; it involves the ureter in 10% [3]. Ureteral endometriosis (UE) is typically unilateral, with a predisposition for the left side in 64% of affected women [4]. The presence of UE is frequently associated with endometriosis of the bladder (47%) and the bowel (43%) [7]. Combined Oral contraceptives and progestins are first-line therapies for pain associated with UE [8], but surgical treatment is necessary to salvage the renal system when UE causes ureteral obstruction [9]. Both conservative procedures (for example, ureterolysis) and more radical surgery (ureteroneocystostomy) are commonly performed [10]. Ureteroneocystostomy has a lower recurrence rate but a higher surgical complication rate than ureterolysis [11]
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