Cases Of Ureteral Endometriosis Research Articles

Ureteral endometriosis in patients with deep infiltrating endometriosis: characteristics and management from a single-center retrospective study.

As a serious type of deep infiltrating endometriosis (DIE), ureteral endometriosis (UE) can result in decreased kidney function. The aims of this study are to investigate risk factors and surgical treatments for UE. The study enrolled 329 patients with deep infiltrating endometriosis, who were treated with laparoscopic surgery between January 2014 to September 2018. All patients were divided into one of two groups: UE or non-UE. Clinical information and other surgery variables of the two groups were examined. Out of 329 patients with DIE, 68 (20.67%) cases of UE were diagnosed. Among them, 37 patients also had hydroureteronephrosis. In a multivariate analysis, the variables revised American Fertility Society (rAFS) stage IV, uterosacral ligament (USL) DIE lesion ≥ 3cm in diameter and previous surgery for endometriosis significantly increased the risk of UE. A total of 27.03% (10/37) of patients with UE and hydroureteronephrosis showed decreased kidney function. Ureterolysis was performed in 59 patients, and an ureteroneocystostomy was performed in 9 patients. A double-J stent was placed in 37 patients with UE. Only 1 patient developed acute pyelonephritis postoperatively. During more than 2years of follow-up, no patient experienced recurrence. The variables of rAFS stage IV, USL DIE lesion ≥ 3cm in diameter and previous surgery for endometriosis significantly increased the risk of UE. Laparoscopic ureterolysis and ureteroneocystostomy are feasible and safe procedures with low complication and recurrence rates.

Ureteroureteral anastomosis for endometriosis involving the ureter: Case series and literature review

Introduction: The purpose of this study was to review operative management of endometriosis involving the ureter. Materials and methods: Retrospective case series of three patients undergoing resection of ureteral endometriosis with ureteroureterostomy for endometriosis involving the ureter by minimally invasive gynecologic surgeons between 2007 and 2018 at a large academic medical center in the Northeastern United States. A literature review was conducted to find cases with a similar approach. Results: Three cases of ureteral endometriosis surgically managed at our institution with ureteroureteral anastomosis were identified. Ureteral endometriosis was identified preoperatively by hydroureteronephrosis on imaging. Intrinsic ureteral endometriosis was confirmed by pathology in two cases; extrinsic endometriosis was grossly visualized in one case. Operative times ranged from 300 to 387 min. Estimated blood loss ranged from 150 to 250 mL. There were no intraoperative complications. A total of 151 cases with a similar approach were described in the literature. Recurrence of obstructive uropathy occurred in 11 cases. Conclusion: Ureteral endometriosis is a rare complication with several management options. Ureterectomy with ureteroureterostomy has been described in the literature and in three cases at our institution with low complication rates and rare stricture formation. This technique can be successful in the management of ureteral endometriosis and warrants further investigation.

Ureteral Endometriosis and Silent Renal Loss: A Retrospective Study

Objective To present six cases of ureteral endometriosis with renal loss managed by a multidisciplinary minimally invasive approach. Introduction Severe ureteral endometriosis can potentially lead to urinary tract obstruction and silent loss of renal function. Nephrectomy should be considered and may be performed by a multidisciplinary minimally invasive approach. Material and methods Retrospective observational study of patients with deep endometriosis with ureteral involvement and consequently loss of renal function who underwent laparoscopic nephrectomy between April 2009 and April 2016 in a tertiary care university hospital. The clinical presentation, imaging characteristics, surgical findings, surgical procedures, operative time, blood loss, postoperative analgesic administration, mean hospital stay and recurrence rates were analyzed. Results The mean age of patients was 28 years (range 26 to 40). Mean overall operative time for the laparoscopic procedures was 382 minutes (range 310 to 705). Mean blood loss was 200 cc and there were no intraoperative complications in our series with no need to laparotomy conversion. Mean overall hospital stay was 157 hours (range 48 to 364). Regarding complications, a case of pyelonephritis and one of urinary retention were registered, the latter requiring bladder neurostimulation 2 years after surgery. All women remain asymptomatic in follow-up. Conclusions In ureteral deep endometriosis, nephrectomy should be considered for significant renal functional impairment associated with persistent ureterohydronephrosis and renal parenchymal atrophy. It may be performed by laparoscopy with minimal morbidity, minimal postoperative discomfort, and a short hospital stay.

Comparison of the post-operative infection by using different type of prophylactic antibiotics and placebo in healthy adult patients who underwent ureterorenoscopic surgery

Comparison of the post-operative infection by using different type of prophylactic antibiotics and placebo in healthy adult patients who underwent ureterorenoscopic surgery

Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series.

In women with deeply infiltrating endometriosis (DIE) what is the prevalence of involvement of endometriotic tissue and fibrosis in ureteral endometriosis (UE), as assessed by histological staining? In women with DIE, ureteral involvement is more often due to endometriotic tissue rather than fibrosis. In the current literature, histological evaluation of ureteral endometriosis is mainly based on the degree of wall infiltration by endometriosis instead of the tissue composition. A few studies reported ill-defined and contradictory histological data on the tissue composition of UE. Retrospective observational study based on clinical records of women affected by DIE, laparoscopically treated for UE at a tertiary referral center, between January 2010 and March 2013. All cases of ureteral nodule excision or ureterectomy with histological examination of the specimens were included. Exclusion criteria were other identified causes of hydroureteronephrosis, medical therapy for a period of at least 3 months before surgery and previous surgery for DIE. A total of 77 patients were included in the study and among them seven (9%) presented with bilateral ureteral involvement, giving a total of 84 cases of UE available for analysis. All patients had stage IV endometriosis. According, respectively, to the presence of endometrial glands and/or stroma cells or of fibrotic tissue only, the endometriotic UE and fibrotic UE groups were compared with regard to hydroureteronephrosis at pre-operative urinary tract computerized tomography scan, type of surgical procedure performed to treat UE (nodule removal or ureterectomy), association with other locations of the disease and post-operative complications (ureteral fistula or stenosis). For the 84 cases of UE, 65 (77%) and 19 (23%), respectively, showed endometriotic tissue and fibrotic tissue only. Presence of hydroureteronephrosis and endometriotic pattern of UE showed a significant association [endometriotic UE 44/65 (68%) versus fibrotic UE 8/19 (42%); P = 0.04]. Fibrotic pattern of UE and presence of concomitant recto-vaginal endometriosis showed a significant association [endometriotic group: 29/65 (45%) versus fibrotic group 18/19 (95%); P < 0.001]. The retrospective and monocentric (tertiary referral center) study design. Besides the distinction between extrinsic and intrinsic UE based on the degree of wall infiltration by endometriosis, a new classification according to the histological pattern of UE could be useful for clinicians, both in the diagnostic and therapeutic fields. None.

Three cases of endometriosis of the urinary tract

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 515% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.

Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis

Backgroundthis study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis.MethodsEighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis), 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median) follow-up.ResultsLaparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period.Conclusionlaparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm) ureteral involvement or with severe stenosis with or without hydronephrosis.

Ureteral endometriosis: clinicopathological and immunohistochemical study of 7 cases

Ureteral endometriosis is a rare yet important entity that can lead to renal failure due to silent obstruction of the ureter. Awareness of clinical and morphologic features can help in early detection and treatment. We analyzed the clinical, pathologic, and immunohistochemical findings of 7 cases of ureteral endometriosis. Mean age of patients was 51 years. All patients presented with hydroureter, accompanied in the most cases by hydronephrosis. Superimposed pyelonephritis was experienced by 2 of 7 patients. Most patients (4 of 7) had previously undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy. In 6 of 7 cases, endometriosis involved the left ureter. The distal one third of the ureter was involved in 6 cases, whereas the middle third was involved in 1 case. In 4 cases, endometriosis was located extrinsic to the ureter, whereas in 3 cases, the ureter showed intrinsic involvement by endometriosis. One case showed simple endometrial hyperplasia. Surgical management included nephrectomy in 2 cases, distal ureterectomy with reimplantation in 3 cases, ureteral stent placement followed by ureteroureterostomy in 1 case, and relief of ureteral obstruction by resection of pelvic endometrioma in 1 case. Immunostains for cytokeratin-7 (CK7) and progesterone receptor (PR) were positive in all of the cases, whereas immunostains for estrogen receptor (ER) were positive in 83% of cases and immunostains for CK20 were negative in all cases. CA125 immunostains were positive in 67% of cases. The stromal cells were positive for CD10, ER, and PR immunostaining. Our findings suggest that the diagnosis of ureteral endometriosis is preceded in most cases by hysterectomy and bilateral salpingo-oophorectomy, possibly because of prior symptoms related to adenomyosis or pelvic endometriosis and that ureteral endometriosis has a strong predilection for involvement of the lower third of the left ureter. Ureteral endometriosis should be included in the differential diagnosis of obstructive ureteral lesions in women, particularly those involving the lower third of the left ureter, even in postmenopausal patients. Immunostains for ER, PR, CK7, CA125, and CD10 can be helpful in challenging cases.

Endoscopic Diagnosis and Management of Ureteral Endometriosis

It is estimated that 1% of patients with endometriosis have involvement of the urinary tract, with the bladder being the most common location. Ureteral endometriosis is a rare entity, and the majority of cases are found at exploratory laparotomy for extensive involvement of the pelvic organs. Obstruction of the ureter may be caused by extrinsic or intrinsic disease, with the extrinsic form occurring four times as often. Progressive ureteral obstruction can be insidious in onset and ultimately lead to renal failure. Hormone therapy has had variable success, and open surgery has been the mainstay of treatment. Only one case of ureteral endometriosis, both intrinsic and extrinsic, diagnosed at ureteroscopy has been reported previously. We present a case of ureteral obstruction secondary to isolated intrinsic endometriosis diagnosed at ureteroscopy and treated endoscopically with holmium laser ablation and leuprolide therapy.

Three Cases of Urinary-Tract Endometriosis with Different Clinical Findings

Endometriosis is the presence of endometrium-like tissue outside the uterus. Ureteral involvement is rare and may result in a high rate of renal loss before it is recognized. Different treatment modalities are reported in the literature, including medical therapy and radical surgery. The authors report three cases of ureteral endometriosis with different clinical features. In one patient, bilateral distal ureterectomy and ureteroneocystostomy was performed, and the histopathologic diagnosis was consistent with intrinsic ureteral endometriosis. In the other two patients, surgical treatment consisted of endometrioma cyst excision, ureterectomy, and ureteroneocystostomy.

Ureteral obstruction due to endometriosis

The authors reports a rare case of ureteral endometriosis with hydronephrosis. Endometriosis was not proven by urological means but was found during open surgery. The value of ureteroscopy in cases of suspected endometriosis is discussed.

Ureteral endometriosis: An endoscopic diagnosis

A case of ureteral endometriosis is reported. This is the first case diagnosed during a ureteropyeloscopic examination.

Ureteral endometriosis in postmenopausal woman

A case of ureteral endometriosis in a fifty-eight-year-old, postmenopausal woman is reported. It is postulated that exogenous estrogen stimulated the growth of endometrial tissue which causes the obstruction of the ureter.