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. 2021 May 17;21(1):206.
doi: 10.1186/s12905-021-01349-7.

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

Kunlin Yang #  1   2   3 , Sida Cheng #  1   2   3 , Yukun Cai  1   2   3 , Jiankun Qiao  1   2   3 , Yangyang Xu  1   2   3 , Xinfei Li  1   2   3 , Shengwei Xiong  1   2   3 , Ye Lu  4 , Aobing Mei  5 , Xuesong Li  6   7   8 , Liqun Zhou  1   2   3
Affiliations

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

Kunlin Yang et al. BMC Womens Health. .

Abstract

Background: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center.

Methods: To 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.

Results: Forty 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.

Keywords: Case report; Nephroureterectomy; Ureteralendometriosis; Ureteroneocystostomy; Ureteroureterostomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Robotic-assisted laparoscopic ureteroureterostomy. a Blue area shows the dilated ureter. b Cutting of the suspensory ligament of the right ovary and resection of the right ovary and endometrial lesion. c Dissection of the distal ureter presenting with stricture (blue area) close to the bladder. d Excision of the ureteral stricture. e–i Ureteroureterostomy
Fig. 2
Fig. 2
Laparoscopic ureteroneocystostomy with psoas hitch. a Dissection of the ureter and the endometrial nodule (red arrow). b The blue arrow shows the ureteral stricture, and the red arrow shows the endometrial nodule. c Excision of the endometrial lesion and cutting of the ureter. d, e Freeing of Retzius’ space. f Extracorporeal creation of a ureteral nipple. g Psoas hitching of the bladder. h, i Anastomosis of the ureter and the bladder
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