Abstract
Deep infiltrating endometriosis of the urinary tract is rare but can result in ureteric obstruction, hydroureteronephrosis and renal failure. Ureteric endometriosis usually affects the distal third of the left ureter among women of reproductive age. Greater awareness of ureteric endometriosis and a multidisciplinary approach in the management is essential to achieve optimal outcomes. We present an atypical case of right ureteric obstruction due to endometriosis at the pelvic brim resulting in complete loss of renal function and necessitating nephroureterectomy.
Highlights
Endometriosis a ects 10%–15% of all women of reproductive age [1]
We present a case of complete loss of one kidney function secondary to ureteric endometriosis at the pelvic brim causing hydroureteronephrosis requiring laparoscopic unilateral nephroureterectomy
Cystoscopy, right retrograde pyelogram (Figure 4) and ureteroscopy (Figure 5) showed a normal bladder, and a blind-ending right ureter compressed by a mass with purple discolouration at the level of the pelvic brim. ere was no evidence of mucosal abnormality, but a wire could not be
Summary
Endometriosis a ects 10%–15% of all women of reproductive age [1]. Women o en present with symptoms such as dysmenorrhoea, pelvic pain, dyspareunia, bowel upset (e.g. constipation, diarrhoea) or pain and infertility [2]. ere are 3 major phenotypes of endometriosis: ovarian endometrioma, super cial peritoneal endometriosis, and deep in ltrating endometriosis (DIE) [3]. DIE of the urinary system is rare and is found in about 1%–5.5% of all women with endometriosis [5], with the bladder, ureter, and kidney being a ected in a ratio of 40 : 5 : 1 [6]. A 47-year-old female, gravida 2 para 0, presented to a general practitioner with fatigue She had no signi cant medical or surgical history. A series of investigations were organised, including a pelvic ultrasound scan which revealed an enlarged, adenomyotic uterus (84 × 67 × 88 mm, volume 260 cc) E dilated right ureter was identi ed at the pelvic brim, with surrounding so tissue density. Cystoscopy, right retrograde pyelogram (Figure 4) and ureteroscopy (Figure 5) showed a normal bladder, and a blind-ending right ureter compressed by a mass with purple discolouration at the level of the pelvic brim. ere was no evidence of mucosal abnormality, but a wire could not be
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