{"paper_id":"5f9205a7-87a5-46a0-ae1d-8d401fb936ed","body_text":"Submit Manuscript | http://medcraveonline.com\nIntroduction\nUreter endometriosis is a rare clinical condition with up to 12% \nof women with endometriosis affected in the urinary tract. 1,2 The \nproportion of involvement of bladder, ureter and kidney is said to \nbe 40:5:1. 3,4 Of special concern ureteral endometriosis is a silent \ndisease with most patients without specific symptoms (related to the \nureter) and, more commonly with pelvic pain (dysmenorrhea and \ndyspareunia) that affects most patients with endometriosis. In patients \nwithout pain symptoms the diagnosis of endometriosis can be delayed \nleading to silent loss of kidney function. 5,6 Ureteral endometriosis \ncan be intrinsic or extrinsic to the ureteral wall. 7,8 Extrinsic type is \nconsidered the most common.9\nSurgical treatment is feasible and safe. 10,11 Ureter endometriosis \ncan be treated either by ureterolysis, segmental ureterectomy with end-\nto-end anastomosis or ureteroneocystostomy. The surgical strategy \npublished by Wattiez et al.,12 starts with retroperitoneal inspection of \nureters. Dissection of the ureter may need to begin at the pelvic brim \nand always strats in sano. We use bipolar forceps and scissors or the \nblunt tip of an aspirator to the dissection aiming to free the ureter from \nthe endometriosis tissue. After ureterolysis the ureter is evaluated to \ncheck for wall stenosis, vascular compromise or with residual tissue. \nIf one of this happens then resection with end-to-end reanastomosis \nor ureteroneocystectomy may be needed. In either case we use the \ndouble J stent keeping it in place until 6-8weeks after ureter resection \ndoing a CT urogram at this time. If only ureterolysis the JJ stent is \nkept until 2weeks after surgery.\nConclusion \nEven if ureteral endometriosis is considered a rare disease it \nshould be always suspected in deep endometriosis patients as part of \nthe surgical strategy. The main advantage is to isolate the rectovaginal \nnodule from the ureter keeping it safe during the surgery but also to \nrule out endometriosis involvement of the ureter that is most often \nwithout specific symptoms. Laparoscopic management of ureter \nendometriosis is feasible and surgeons should consider ureterolyis \nand if after that the ureter is compromised the either ureter partial \nresection with end-to-end anastomosis or ureteroneocystostomy.\nAcknowledgements\nNone.\nConflict of interest\nThe author declares no conflict of interest.\nReferences\n1. Gustilo-Ashby AM, Paraiso MF. Treatment of urinary tract endometrio-\nsis. J Minim Invasive Gynecol. 2006;13(6):559–565.\n2. Nezhat C, Nezhat F, Nezhat CH, et al. Urinary tract endometriosis treat-\ned by laparoscopy. Fertil Steril. 1996;66(6):920–924.\n3. Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of \ndeeply infiltrating endometriosis: surgical implications and proposition \nfor a classification. Hum Reprod. 2003;18(1):157–161.\n4. Collinet P, Marcelli F, Villers A, et al. Management of endometriosis of \nthe urinary tract. Gynecol Obstet Fertil. 2006;34(4):347–352.\n5. Seracchioli R, Mabrouk M, Manuzzi L, et al. Importance of retroperi -\ntoneal ureteric evaluation in cases of deep infiltrating endometriosis. J \nMinim Invasive Gynecol. 2008;15(4):435–439.\n6. Sanyal D, Argent VP. Silent pelvic endometriosis presenting as pyelone-\nphritis and ureteric obstruction. J Obstet Gynaecol. 2003;23(3):328–329.\n7. Frenna V , Santos L, Ohana E, et al. Laparoscopic management of \nureteral endometriosis: our experience. J Minim Invasive Gynecol . \n2007;14(2):169–1671.\n8. Stillwell TJ, Kramer SA, Lee RA. Endometriosis of ureter. Urology. \n1986;28(2):81–85.\n9. Chapron C, Chiodo I, Leconte M, et al. Severe ureteral endometriosis: \nthe intrinsic type is not so rare after complete surgical exeresis of deep \nendometriotic lesions. Fertil Steril. 2010;93(7):2115–2120.\n10. Lusuardi L, Hager M, Sieberer M, et al. Laparoscopic treatment of in -\ntrinsic endometriosis of the urinary tract and proposal of a treatment \nscheme for ureteral endometriosis. Urology. 2012;80(5):1033–1038.\n11. Gabriel B, Nassif J, Trompoukis P, et al. Prevalence and manage -\nment of urinary tract endometriosis: a clinical case series. Urology. \n2011;78(6):1269–1274.\n12. Wattiez A, Puga M, Albornoz J, et al. Surgical strategy in endometriosis. \nBest Pract Res Clin Obstet Gynaecol. 2013;27(3):381–392.\n80\n© 2016 Alves. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits \nunrestricted use, distribution, and build upon your work non-commercially.\nUreter endometriosis\nVolume 2 Issue 3 - 2016\nJoao Sequeira Alves\nHospital Garcia de Orta, Serviço Obstetrícia, Almada, Europe\nCorrespondence: Joao Sequeira Alves, Hospital Garcia \nde Orta, Serviço Obstetrícia, Almada, Portugal, Europe, T el \n+351966125130, Email jmiguelalves@gmail.com\n \nReceived: July 26, 2016 | Published: August 08, 2016\nAbstract\nUreter endometriosis is a rare clinical condition that can present itself as a silent kidney \nloss. This condition should be suspected in rectovaginal endometriosis treatment. This \ntreatment is feasible by laparoscopy with ureterolysis, end-to-end anastomosis or re-\nimplantation.\nKeywords: endometriosis, ureter, laparoscopy\nMOJ W omen’s Health \nMini Review\n Open Access\nCitation: Alves JS. Ureter endometriosis. MOJ Womens Health. 2016;2(3):80. DOI: 10.15406/mojwh.2016.02.00033","source_license":"CC0","license_restricted":false}