Ureteral Endometriosis Research Articles

Laparoscopic Ureteral End to End Anastomosis for Intrinsic Ureteral Endometriosis

Objective: To present an interesting case of intrinsic ureteral endometriosis causing complete ureteral obstruction and its surgical management with laparoscopic end-to-end ureteral anastomosis.

Left Pelvic Kidney and Extrinsic Ureteral Endometriosis

Left Pelvic Kidney and Extrinsic Ureteral Endometriosis

653 - Bladder Endometriosis: A Case Report Involving Laparoscopic Ureteral Reimplantation

Objective: Urinary endometriosis affects most frequently the bladder and the ureter. Despite bladder endometriosis usually causes urinary discomfort, ureteral endometriosis is often asymptomatic and can lead to loss of kidney function.

OP12.05: Ureteric endometriosis: detection and assessment of level of obstruction at sonovaginography for deep infiltrating endometriosis (DIE)

OP12.05: Ureteric endometriosis: detection and assessment of level of obstruction at sonovaginography for deep infiltrating endometriosis (DIE)

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis.

Extrapelvic endometriosis is a rare entity that presents serious challenges to researchers and clinicians. Endometriotic lesions have been reported in every part of the female human body and in some instances in males. Organs that are close to the uterus are more often affected than distant locations. Extrapelvic endometriosis affects a slightly older population of women than pelvic endometriosis. This might lead to the assumption that it takes several years for pelvic endometriosis to “metastasize” outside the pelvis. All current theories of the pathophysiology of endometriosis apply to some extent to the different types of extrapelvic endometriosis. The gastrointestinal tract is the most common location of extrapelvic endometriosis with the urinary system being the second one. However, since sigmoid colon, rectum, and bladder are pelvic organs, extragenital pelvic endometriosis may be a more suitable definition for endometriotic implants related to these organs than extrapelvic endometriosis. The sigmoid colon is the most commonly involved, followed by the rectum, ileum, appendix, and caecum. Most lesions are confined in the serosal layer; however, deeper lesion can alter bowel function and cause symptoms. Bladder and ureteral involvement are the most common sites concerning the urinary system. Unfortunately, ureteral endometriosis is often asymptomatic leading to silent obstructive uropathy and renal failure. Surgical excision of the endometriotic tissue is the ideal treatment for all types of extrapelvic endometriosis. Adjunctive treatment might be useful in selected cases.

Robotic Approach to Ureteral Endometriosis: Surgical Features and Perioperative Outcomes.

Introduction: Surgical treatment of ureteral endometriosis is necessary to relieve urinary symptoms of obstruction and to preserve renal function. Which surgical approach to ureteral endometriosis should be considered the most appropriate is debated, due to the lack of scientific evidence. The aim of the present study is to assess the feasibility and to describe the perioperative outcomes of minimally invasive treatment of deep ureteral endometriosis using robotic assistance, highlighting the technical benefits and the limits of this approach.Method: A case-series including 31 consecutive patients affected by high-stage endometriosis including ureteral endometriosis using robotic assistance in our Department between November 2011 and September 2017.Results: All procedures were successfully completed by robotic technique, resulting in full excision of the parametrial nodules involving the ureter. Mean operating time was 184.8 ± 81 min. Mean hospital stay was 4.02 ± 3 days. Perioperative complications occurred in five patients and 4 out of 5 involved the urinary tract.Conclusions: Robotic surgery for deep infiltrating endometriosis of the ureter was feasible and allowed complete resection of ureteral nodules in all cases. No intraoperative complications arose, but a non-negligible rate of urinary tract complications was detected. This calls for a careful assessment of the benefits and specific risks associated with the use of robotic surgery for the treatment of deep infiltrating endometriosis of the ureter.

Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility.

The ureter is the second most common site affected by urinary tract endometriosis, after the bladder. Optimal strategies in the diagnosis and treatment of ureteral endometriosis (UE) are not yet well defined. The aim of this study was to systematically review evidence regarding the epidemiology, pathophysiology, diagnosis, medical and surgical treatment, impact on fertility and risk of malignant transformation of UE. A systematic literature review, by searching the MEDLINE and PUBMED database until April 2018, was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/PROSPERO CRD42017060065). A total of 67 articles were selected to be included in this review. The involvement of the ureter by endometriosis is often asymptomatic or leads to non-specific symptoms. When the diagnosis is delayed, UE may lead to persistent hydronephrosis and eventually loss of renal function. Ultrasonography is the first-line technique for the assessment of UE; alternatively, magnetic resonance imaging provides an evaluation of ureteral type involvement. The surgical treatment of UE aims to relieve ureteral obstruction and avoid disease recurrence. It includes conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneocystostomy performed in relation to the type of ureteral involvement. Fertility and pregnancy outcomes are in line with those observed after surgical treatment of deep infiltrating endometriosis (DIE). Current evidence does not support the potential risk of malignant transformation of UE. In this article, we review available evidence on ureteral endometriosis, providing a useful tool to guide physicians in the management of this disease. Diagnosis and management of UE remain a challenge. In relation to the degree of ureteral involvement and the association with other DIE implants, the surgical approach should be planned and carried out in an interdisciplinary collaboration between gynecologist and urologist.

Total Laparoscopic Ureteroneocystostomy for Ureteral Endometriosis: A Single-Center Experience of 160 Consecutive Patients

Study ObjectiveTo investigate the efficacy of laparoscopic ureteroneocystostomy in patients with deep infiltrating endometriosis (DIE) with ureteral, parametrial, and bowel involvement. DesignProspective study (Canadian Task Force classification II-2). SettingTertiary referral center for endometriosis care. PatientsOne hundred sixty patients with DIE underwent laparoscopic radical eradication and ureteroneocystostomy between January 2009 and December 2016. InterventionsLaparoscopic nerve-sparing radical treatment with ureteroneocystostomy, parametrectomy, and, if necessary, segmental bowel resection. Measurements and Main ResultsSurgical eradication was radical, and ureteral endometriosis was histologically confirmed in all patients (45.6% intrinsic and 54.4% extrinsic). In 58.7% of patients ureteroneocystostomy was performed with the psoas hitch technique. Bowel resection was performed in 121 patients (75.6%), and 115 of them had a concomitant ileostomy (71.9%). Unilateral parametrectomy was performed on the left side in 61.9% of patients and on the right side in 30% of patients, respectively, whereas bilateral parametrectomy was completed in 33 patients (20.6%). Postoperative complications were infrequent: 7 patients underwent reoperation (4.4%), 8 patients experienced fever (5%), 4 patients required blood transfusion (2.5%), 3 patients had intestinal fistulas (1.9%), and 24 patients experienced impaired bladder voiding (15%) after 6 months. Mean follow-up time was 20.5 months (range, 1–60). The study reported good clinical and surgical results, with a regression of symptoms (p < .001) and recurrence of parametrial endometriosis of 1.2% that required opposite-side ureteroneocystostomy. ConclusionThis is the largest documented series of patients with DIE undergoing laparoscopic radical eradication and ureteroneocystostomy. The collected data show that in patients with ureteral endometriosis, this technique is feasible, effective, and safe and provides good results in terms of relapses and symptoms' control.

Endoscopic laser ablation of ureteral endometriosis

A 37-year-old female with a known history of endometriosis presented with progressive dysmenorrhea and dyspareunia, and complaints of hematuria. After cystoscopy and bilateral retrograde pyelography was performed, distal stenosis in the right ureter without ureteral obstruction and renal impairment was diagnosed. Abdominal hysterectomy and excision of peritoneal endometriotic lesions on the surface of the right ureter and bladder wall was done preserving the ovaries. The intrinsic endometriotic lesion in the right ureter was detected ureteroscopically and histologically and treated successfully by holmium laser ablation avoiding ureteral resection and re-implantation.

Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report

BackgroundThis aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function.Case presentationA 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected.ConclusionsThe nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis.

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

Laparoscopic Ureteroneocystostomy with a Vesicopsoas Hitch in 10 Steps

Study ObjectiveLaparoscopic ureteroneocystostomy with a vesicopsoas hitch has the advantages of a minimally invasive approach. The standardization and description of the technique are the main objectives of this video. We described this procedure in 10 steps, which could help to understand and perform this procedure. MethodsThis video presents an approach to laparoscopic ureteroneocystostomy with a vesicopsoas hitch, which was clearly divided into 10 steps. The local institutional review board was consulted and ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case. The patient cannot be identified, and she gave informed consent. ResultsThe 10 steps are as follows: step 1, identification of the healthy ureter; step 2, identification of the stenotic part; step 3, section of the ureter; step 4, bladder mobilization; step 5, anterior cystostomy; step 6, psoas hitch; step 7, closure of the anterior cystostomy; step 8, posterior spatulation of the ureter; step 9, cystostomy of the superolateral bladder dome; and step 10, ureteral suture to the bladder. ConclusionLaparoscopic ureteroneocystostomy with a vesicopsoas hitch is an effective technique for intrinsic ureteral endometriosis; it usually needs ureteral resection with end-to-end reanastomosis or reimplantation if the anastomosis is in tension. The 10 steps help to perform each part of surgery in logical sequence, making the procedure faster to adopt and learn. The standardization of laparoscopic techniques could help to reduce the learning curve.

310 - Laparoscopic Ureteroneocystostomy for Ureteral Endometriosis

Endometriosis is a common disease associated with chronic pelvic pain and infertility. For ureteral endometriosis, which is rare, conventional therapy previously consisted of laparotomy. However, laparoscopic ureteroneocystostomy has been reported recently. Laparoscopic surgery for ureteral endometriosis requires greater surgical expertise and takes a longer time to master. The minimally invasive approach is well known to give patients benefits because of its small incision, less pain and shorter hospital stay. We performed ureteroneocystostomy for 17 patients between January 2008 and December 2016.

205 - Robotic-Assisted Laparoscopic Management of Bilateral Ureteral Endometriosis: Ureterocystoneostomy with Psoas Hitch

205 - Robotic-Assisted Laparoscopic Management of Bilateral Ureteral Endometriosis: Ureterocystoneostomy with Psoas Hitch

57 - Total Laparoscopic Ureteroneocystostomy for Ureteral Endometriosis: A Single Center Experience on 160 Consecutive Cases

Study Objective: To investigate the efficacy of laparoscopic ureteroneocystostomy in patients with deep infiltrating endometriosis (DIE) with ureteral and parametrial involvement.

Severe ureteral endometriosis: frequency and risk factors

Ureteral endometriosis (UE) can be classified as severe when there is obstruction to urinary flow (ureteral compression (UC)). In this retrospective study on 205 patients, we evaluated intraoperatively the frequency of severe ureteral endometriosis (UE) in women with UE and, secondarily, risk factors associated with UC. We documented intraoperatively ureteral UC in 124 (60.5%) patients with UE. A significantly lower body mass index (BMI) was observed in women with UC than in women without UC (p = .02). A significant association was found between UC and parametrial endometriosis (p = .001). In multivariable analysis, these variables remained significantly associated with UC. Ureteral compression is common in patients with UE, especially in women with parametrial infiltration and a low BMI.

Laparoscopic treatment of ureteral endometriosis: with and without robotic assistance

Laparoscopic treatment of ureteral endometriosis: with and without robotic assistance

Paraureteral Endometriosis with Bilateral Gross Hydroureters and Left Renal Compromise

Deep endometriosis is usually defined as endometriosis infiltrating the peritoneum by >5 mm. It sometimes involves the ureter, causing hydronephrosis in 5% of cases. The latter is associated with 18% of ureteral lesions. Ureteral endometriosis is one of the rare causes of silent kidney failure. Ureter obstruction can lead to urinary tract obstruction, hydronephrosis, and hydroureters. The ureters are usually compressed externally by the endometriotic lesions surrounding them causing extrinsic ureteral endometriosis and sometimes by pressure from the bulky adenomyotic uterus with paraureteral fibrosis.

Endometriosis of the ureteral stump: an entity with severe manifestations

A 50-year-old woman on continuous oral estroprogestin therapy and with a history of endometriosis presented with gross hematuria and right reno-ureteral colic pain. Fifteen years before she had undergone total nephrectomy for loss of function of her right kidney due to an ureteral endometriotic nodule resulting in ureteral obstruction. The ureter had not been removed. For the following 15 years-period she had not manifested symptoms or signs of endometriosis. Although imaging investigations allowed to suspect endometriosis of the ureteral stump, urothelial cancer or carcinoma arising in endometriosis nodule could not be excluded. A laparoscopic hysterosalpingo-oophorectomy with the residual ureteral stump removal was performed. Some endometriotic implants on the ureteral stump wall were histologically detected. Proximal ureterectomy should be recommended in patients affected by ureteral endometriosis with a non-functioning kidney since long-term severe complications could derive from the residual stump. A continuous estroprogestin therapy does not totally prevent these complications.

A CASE OF URETERAL ENDOMETRIOSIS

A 49-year-old woman was admitted to our hospital due to macroscopic hematuria. Contrast-enhanced computed tomography revealed left hydronephrosis, a tumor at her left ureter, pseudoaneurysm and ovarian cystoma. Prior to the operation, the tumorous lesion was considered as left ureteral cancer without metastasis (cT4N0M0; stage IV). Left nephroureterectomy was performed. After the surgery, pathological examination revealed that this lesion was extrinsic endometriosis originating from the ureter.We here report this case of ureteral endometriosis that presented with atypical clinical findings along with a review of the literature.