{"paper_id":"186fc33c-b4b1-4e3b-a125-97973d8cc545","body_text":"Abstract\nBackground\nUrinary tract endometriosis (UTE) is a rare manifestation of deep infiltrating endometriosis (DIE) and is often underdiagnosed due to nonspecific or absent urinary symptoms. Delayed recognition may result in progressive ureteric obstruction and silent renal function loss. This study aimed to evaluate the incidence, clinical presentation, imaging findings, surgical management, and outcomes of patients with UTE managed at a tertiary referral center.\nMethods\nA retrospective observational study was conducted at GEM Hospital, Coimbatore, between January 2020 and December 2025. Among 496 women evaluated for endometriosis, 12 patients diagnosed with UTE were included. Demographic details, clinical features, magnetic resonance imaging (MRI) findings, intraoperative observations, surgical procedures, and postoperative outcomes were analyzed. Surgical management was individualized and included laparoscopic ureterolysis, ureteric stenting or reimplantation, bladder lesion excision, or segmental bladder resection.\nResults\nThe mean age was 38.75 ± 6.29 years. Ureteric involvement was observed in seven patients (58%) and bladder involvement in five (42%). Dysmenorrhea was the most common symptom (66%), while one patient was asymptomatic. MRI identified hydroureteronephrosis in all ureteric cases, predominantly due to extrinsic compression. Laparoscopic ureterolysis successfully relieved obstruction in most patients. Definitive surgery was performed in nine patients, while fertility-preserving procedures were done in three. All patients were symptom-free at follow-up, with no major complications.\nConclusion\nUTE, though rare, carries a significant risk of silent renal damage. Early clinical suspicion, MRI-based evaluation, and timely multidisciplinary laparoscopic management are crucial for renal preservation and favorable outcomes.\nSimilar content being viewed by others\nAbbreviations\n- DIE:\n-\nDeep infiltrating Endometriosis\n- UTE:\n-\nUrinary tract endometriosis\n- MRI:\n-\nMagnetic resonance imaging\n- HUN:\n-\nHydronephrosis/hydroureteronephrosis\n- DTPA:\n-\nDynamic renal scintigraphy using technetium-99 m diethylenetriamine pentaacetic acid\nReferences\nLeonardi M, Espada M, Kho RM, Magrina JF, Millischer AE, Savelli L, et al. Endometriosis and the urinary tract: from diagnosis to surgical treatment. Diagnostics (Basel). 2020;10(10):771–81.\nD’Alterio MN, D’Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management challenges of deep infiltrating endometriosis. Int J Fertil Steril. 2021;15(2):88–94.\nSaadeh R, Finianos E, Hajj HE. Urinary tract endometriosis: a review of literature. Clin Exp Obstet Gynecol. 2024;51(8):172–80.\nDurant Des Aulnois C, Razakamanantsoa L, Crestani A, Abrahami Y, Doizi S, Gomez F, et al. Urinary tract endometriosis: Revisiting the definition of ureterolysis. Int J Gynaecol Obstet. 2024;165(2):345–52.\nBarra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, et al. Ureteral endometriosis: epidemiology, pathogenesis, diagnosis, treatment, fertility, and risk of malignant transformation. Hum Reprod Update. 2018;24(6):710–30.\nSillou S, Poirée S, Millischer AE, Chapron C, Hélénon O. Urinary endometriosis: MR imaging appearance with surgical and histological correlations. Diagn Interv Imaging. 2015;96(4):373–81.\nBusard MPH, Mijatovic V, Lüchinger AB, Bleeker MCG, Pieters-van den Bos IC, Schats R, et al. MR imaging of bladder endometriosis and its relationship with the anterior uterine wall. Eur J Radiol. 2012;81(9):2106–11.\nKołodziej A, Krajewski W, Dołowy Ł, Hirnle L. Urinary tract endometriosis. Urol J. 2015;12(4):2213–7.\nKnabben L, Imboden S, Fellmann B, Nirgianakis K, Kuhn A, Mueller MD. Urinary tract endometriosis in patients with deep infiltrating endometriosis. Fertil Steril. 2015;103(1):147–52.\nNerli RB, Nutalapati S, Patel P, Bellad MB, Ghagane SC. Ureteral endometriosis: our experience. Indian J Obstet Gynecol Res. 2025;7(3):374–8.\nPiriyev E, Schiermeier S, Römer T. Bladder endometriosis: diagnosis, therapy, and outcome of a single-center experience. Diagnostics (Basel). 2025;15(4):466–75.\nMaccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, et al. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int. 2012;89(3):249–58.\nHernández Gutiérrez A, Spagnolo E, Hidalgo P, López A, Zapardiel I, Rodriguez R. Magnetic resonance imaging versus transvaginal ultrasound in deep infiltrating endometriosis. Int J Gynaecol Obstet. 2019;146(3):380–5.\nLeone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder endometriosis: Systematic review of pathogenesis, diagnosis, treatment, and fertility impact. Eur Urol. 2017;71(5):790–807.\nGupta DK, Singh V, Sinha RJ, Sankhwar PL. Ureteric endometriosis with adenomyosis leading to loss of renal function. Urol Int. 2012;5(4):210–4.\nPalla VV, Karaolanis G, Katafigiotis I, Anastasiou I. Ureteral endometriosis: a systematic review. Indian J Urol. 2017;33(4):276–82.\nKumar S, Tiwari P, Sharma P, Goel A, Singh JP, Vijay MK, et al. Urinary tract endometriosis: review of 19 cases. Urol Ann. 2012;4(1):6–12.\nWang P, Wang XP, Li YY, Jin BY, Xia D, Wang S, et al. Hydronephrosis due to ureteral endometriosis in women of reproductive age. Int J Clin Exp Med. 2015;8(1):1059–65.\nLeonardi M, Condous G. Redefining ureterolysis to mirror the skills of modern gynecologists. J Minim Invasive Gynecol. 2020;27(7):1443–5.\nAcknowledgements\nThe authors would like to acknowledge the multidisciplinary team at GEM Hospital, Coimbatore, including the departments of Gynecology, Urology, Radiology, and Anesthesiology, for their collaborative support in the diagnosis, surgical management, and follow-up of patients included in this study. We also thank the medical records department for assistance with data retrieval.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare that have no conflict of interest.\nEthical Approval\nAll procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\nInformed Consent\nInformed consent was obtained from the patients included in the study.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nDuraiswamy, K.Y., Meghana, K., Dharshini, S. et al. The Silent Kidney—Unmasking the Urinary Tract Involvement in Endometriosis—An Observational Study at a Tertiary Care Hospital. J Obstet Gynecol India (2026). https://doi.org/10.1007/s13224-026-02389-5\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s13224-026-02389-5","source_license":"CC0","license_restricted":false}