{"paper_id":"617b4169-6e60-4cf9-96c8-990c4bcb5b86","body_text":"Clinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 1 of 18 \n \n \nEndometriosis of the Kidney and the Urinary Tract Organs an Update \nAnthony Kodzo-Grey Venyo  \nRecently retired UK Clinician, P.O. Box LG 213, Legon, University of Ghana, LEGON, ACCRA, GHANA.  \n*Corresponding Author: Anthony Kodzo-Grey Venyo, recently retired UK Clinician, P.O. Box LG 213, Legon, University of Ghana. Legon, \nAccra, Ghana. \nReceived Date: April 02, 2025; Accepted Date: April 17, 2025; Published Date: April 23, 2025 \nCitation: Grey Venyo AK, (2025), Endometriosis of the Kidney and the Urinary Tract Organs an Update , Clinical Medical Reviews and Reports, \n7(2); DOI:10.31579/2690-8794/254 \nCopyright: © 2025, Anthony Kodzo-Grey Venyo. This is an open access article distributed under the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. \nAbstract \nEndometriosis of urogenital tract organs includes the presence of endometrial glands and stroma within or \nencompassing the urethra, the urinary bladder, the ureters, the renal pelvis or the kidney. Traditionally, endometriosis \nof the urinary tract had been  iterated to be a rare clinical entity with an incidence of 1% to 5.5% in patients with \nendometriosis. Nevertheless, some authors had indicated that endometriosis of the urinary tract afflicts the kidney \nand urinary tract organs more frequently than had been previously presumed, particularly in the scenario of patients \nwho have been afflicted by deep infiltrating endometriosis. It had been iterated in a publication previously that \nureteric involvement in of endometriosis had been observed in 14.2% of 315 pa tients with endometriosis. Other \nauthors in the past had documented a prevalence of urinary tract endometriosis of 19.5% in 221 patients with deep \ninfiltrating endometriosis. These previous documentations may indicate that that the prevalence of urinary tr act \nendometriosis had often been underestimated. In view of the fact that endometriosis of the urethra, urinary bladder, \nureter, and the kidney manifests with non -specific symptoms and signs, the diagnosis and management of urinary \ntract endometriosis had remained a challenge. Early diagnosis of endometriosis afflicting the kidney and urinary tract \norgans is crucial for the prognosis. When the diagnosis is delayed, endometriosis of the ureter could emanate in the \ndevelopment of serious complications such as stenosis of the ureter, with hydroureter and hydronephrosis and finally \nloss of kidney function. Some cases of endometriosis had tended to be treated with medicaments; nevertheless, \nsurgery has been regarded as the gold standard in the treatment of patients who had been afflicted by deep infiltrating \nendometriosis. Many publications had demonstrated the feasibility, effectiveness, as well as safety of the \nlaparoscopic approach. In the case of endometriosis of the ureter, the objective of the treatment has tended to be the \nrelease of the ureter from all endometriotic tissue to enable normal function and to avoid morbidity. In the scenario \nof ureteric obstruction by endometriosis, some of the initial management options do include insertion of per -\ncutaneous nephrostomy or insertion of retrograde ureteric stent to maintain renal function preceding the undertaking \nof definite treatment procedures. Some cases of endometriosis of the ureter had been managed by ureterolysis; \nnevertheless, it has remained controversial whether ureterolysis is sufficient or whether more invasive methods such \nas ureterectomy are necessary to prevent recurrence. Treatment of endometriosis of the urinary has tended to consist \nof complete surgical excision of the urinary bladder lesion. So me authors had pointed out that partial cystectomy \ndoes appear to be superior to the undertaking of trans-urethral resection of the urinary bladder lesion demonstrating \nlower recurrence rates. With the development of minimal invasive surgical procedures, other options that had recently \nbeen undertaken by some authors and could be undertaken in the future by other clinicians to attain effective initial \nresults include: cryotherapy, radiofrequency ablation, irreversible electroporation, thermotherapy, and sel ective \nangiography and super-selective embolization of the arterial branch supplying the endometriosis lesion if a pathology \nexamination is obtained from biopsy of the specimen preceding the definitive procedure. The manifesting symptoms \nof urogenital endo metriosis are often non -specific. In view of the possibility of serious complications, clinicians \nincluding urologists need to be aware of endometriosis of the kidney and urinary tract organs and its management \noptions. Establishment of pre-operative diagnosis of endometriosis of the kidney and urinary tract organs might help \nin the planning of intra-operative management of the lesion. \nKeywords: endometriosis; kidney; renal pelvis; ureter; urinary bladder; urethra; biopsy; histopathology; \nradiology image; ultrasound scan; nephrostomy; excision; minimal invasive procedure; laparoscopy \n  Open Access  \n Research Article \n           Clinical Medical Reviews and Reports \n                                                                       Anthony Kodzo-Grey Venyo *                                                                                                                                                        \nAUCTORES \nGlobalize your   Research \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 2 of 18 \n  \nIntroduction \nEndometriosis is a terminology that is used for the presence of ectopic \nendometrial tissue outside the myometrium. [1] Endometriosis is iterated to \nafflict 10% to 15% of premenopausal women, who are aged usually between \n30 years and 35 -years. [1] [2] It ha s been stated that the median age for \ndiagnosis of extragenital lesions is between 35 years and 40 years, which is \nabout 5 years older than that of genital tract lesions. [1] [3] [4] It has been \npointed out that extra genital endometriosis may afflict any tissue. [1] It has \nalso been stated that endometriosis afflicting the renal tract is rare and is \nusually associated with evidence of previous pelvic endometriosis. \nEndometriosis of the kidney and upper urinary tract is very rare. It had been \npointed out th at Marshall [5] had described the first case of renal \nendometriosis. [1] It has furthermore, been iterated that less than 25 cases of \nrenal endometriosis of the kidney had been reported previously in the \nliterature. [1] Endometriosis of the kidney, and upper urinary tract manifests \nwith non-specific symptoms and signs and without a high-index of suspicion, \nthere is a possibility that the diagnosis could be either delayed or the lesion \ncould be misdiagnosed.  \nAim  \nTo update the literature of endometriosis of the kidney and upper urinary \ntract organs.  \nMethods  \nInternet databases were searched including: Google; google scholar; yahoo; \nand PUBMED. The search words that were used included: Endometriosis; \nEndometriosis of kidney; Renal endometriosis; endometriosis of renal \npelvis; endometriosis of ureter; and ureteric endometriosis; endometriosis of \nbladder; endometriosis of urethra. Seventy -six (76) references were \nidentified which were used to write the article in two parts: (A) Overview, \nand (B) Miscellaneous narrations and discussions from some case reports, \ncase series, and studies related to endometriosis of the kidney and upper \nurinary tract organs.   \nResults  \n[1] OVERVIEW  \nDefinition / general statement  \n• Endometriosis is a terminology that is used for presence of \nendometrial tissue outside of the endometrium and myometrium, \nconsisting of both endometrial glands and stroma. [6]  \nEssential features \n• It has been stated that the essential features of endometriosis \ninclude: ectopically located endometrial tissue consisting of at \nleast 2 of the following: endometrial type glands, endometrial \ntype stroma or evidence of chronic haemorrhage. [6] \n• Endometriosis is associated with ovarian clear cell carcinoma \nand endometrioid carcinoma and shares similar molecular \nalterations. [6] \n• It had been iterated that endometriosis in patients without cancer \nharbours oncogenic mutations \nin ARID1A, PIK3CA, KRAS and PPP2R1A, suggesting a \nneoplastic nature in some cases [6] [7]  \n• It has been documented that CD10 immunohistochemistry can \nbe used to confirm the presence of endometrial stroma. [6]  \nTerminology \nIt has been iterated that the ensuing terminologies had been used for \nendometriosis: [6] \n• Endometriotic cyst / endometrioma: cystic form of \nendometriosis \n• Atypical endometriosis: endometriosis with cytologic atypia or \ncrowded glands lined by atypical epithelium resembling \nendometrial atypical hyperplasia. [8]  \nEpidemiology \nThe epidemiology of endometriosis had been summated as follows: [6] \n• Endometriosis afflicts 5% to 15% women of reproductive age. \n• The peak incidence of endometriosis is between: 30 years and \n45 years of age. \n• Oestrogen dependent endometriosis; can rarely affect \nindividuals who are assigned male at birth taking large doses of \noestrogen. [9]   \nSites \nThe sites of the human body that tend to be affected by endometriosis had \nbeen summated as follows: [6] \n• The Ovary (67%) tends to be affected by endometriosis which \ntends to be more common or > within the anterior and posterior \ncul de sac and which is higher or more common (>) in the \nposterior broad ligaments, uterosacral ligaments and more \ncommon of higher t han (>) the uterus > fallopian tubes \n> sigmoid colon and appendix > round ligaments. [10]  \n• It has been stated also that endometriosis is also seen in  the \nurinary bladder and uterine cervix. [6]  \n• It had furthermore been iterated that endometriosis is rarely in \nremote sites such as the lung, regional lymph nodes or skin. [6]  \nPathophysiology \nThe pathophysiology of endometriosis had been summated as follows: [6]  \n• Retrograde menstruation hypothesis: it had been postulated that \nendometrial lining cells travel backwards through fallopian tubes \nduring menses to reach the peritoneal cavity, proliferate and \ncause chronic inflammation with formation of adhesions. [11]   \n• Coelomic metaplasia hypothesis: it had also been postulated that \nin endometriosis, metaplastic transformation of coelomic cells \nlining the pelvic peritoneum do occur. [12]  \n• Induction hypothesis: It had also been iterated that the \ndevelopment of endometriosis ensues a combination of the first \n2 theories. [13]  \n• It had been iterated that in cases of endometriosis, development \nof malignant neoplasm occurs in < 1% of cases; 75% of \nmalignant neoplasms arise in ovarian endometriosis [12] \nAetiology \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 3 of 18 \nThe ensuing iteration had been made regarding the aetiology of \nendometriosis: [6] \n• The development of endometriosis is associated with \nOrganochlorine pollutant exposure. [14]  \nClinical features \nThe clinical manifestations of endometriosis had been summated to include \nthe ensuing: [6] \n• Pelvic pain. [15]  \n• Dyspareunia. \n• Dysmenorrhea. \n• Infertility.  \n• Rarely, infection or rupture of an endometriotic cyst with ascites \nor hemoperitoneum \nDiagnosis \nThe diagnosis of endometriosis had been summated as follows: [6] \n• Laparoscopy is required for definitive diagnosis, even though \nabout 50% laparoscopic biopsy specimens contain microscopic \nendometriosis. [16]  \n• Endometriosis within the pelvis is categorized as superficial \nperitoneal, ovarian and deeply infiltrating endometriosis.  \nRadiology description \nThe radiology-imaging description of endometriosis had been summated as \nfollows: [6]  \n• Ultrasound scan is stated to be mostly used for the assessment of \novarian endometriotic cysts \n• It has been iterated that ultrasound scan of endometriosis \ntypically demonstrates multilocular cysts with septations and \nhyperechoic mural nodules. [6] [17]  \nPrognostic factors \nFactors of prognostication associated with endometriosis had been \nsummated as follows: [6] \n• In the scenario of endometriosis, the risk of development of \nmalignant neoplasm is estimated at 1% for premenopausal \nwomen and up to 2.5% for postmenopausal women \n• About 75% of neoplasms complicating endometriosis are stated \nto arise within the ovary; most common extraovarian site is \nrectovaginal septum. [6] \no It has been iterated that there is an increased risk of \nendometrioid carcinoma followed by clear cell \ncarcinoma [18]  \no Other associated neoplasms noted with endometriosis \nhad been stated to include: seromucinous neoplasms \n(mainly borderline), endometrioid adenofibromas and \nborderline neoplasms, adenosarcomas and \nendometrial stromal sarcomas. [19]  \n• It had been stated that women with carcinoma arising within \nendometriosis tend to be premenopausal, obese and with history \nof unopposed oestrogens. [20]  \n• It had been documented that endometriosis associated \ncarcinomas (other than clear cell) tend to be lower grade and \nstage than similar ovarian carcinoma without associated \nendometriosis. [21]  \nTreatment \nThe treatment of endometriosis had been stated to include the ensuing: [6] \n• Endometriosis associated pain is stated to be treated with non -\nsteroidal anti -inflammatory drugs (NSAIDs), hormonal \ncontraceptives, GnRH analogues and aromatase inhibitors. [15]  \n• Surgical resection of the endometriosis lesion. [6]  \nGross description \nMacroscopy examination features of endometriosis had been summated as \nfollows: [6] \n• Ovarian endometriotic cysts (endometriomas) are stated to have \nfibrotic walls, a smooth lining and dark brown cyst contents \n(chocolate cyst), often adherent to adjacent organs. [6] \n• Polypoid endometriosis is stated to have a polypoid \nconfiguration that raises the differential diagnosis of a neoplasm \non gross and intraoperative examination. [22]  \n• Macroscopy examination of specimens of endometriosis had \nbeen stated to demonstrate the ensuing: Red, brown, white \nplaques, sometimes with a gelatinous appearance [6] [15] [23]  \nFrozen section description \nFrozen section examination features of specimens containing \nendometriosis had been summated as follows: [6] \n• Cytology examination of specimens containing endometriosis is \nstated to demonstrate presence of endometrial glands or \nendometrial stroma [23]  \no It has been iterated that sometimes only macrophages \nand hemosiderin are present or found (and hence the \npathologist undertakes the diagnosis as consistent with \nclinical impression of endometriosis, as other causes \nare possible) \n• Cytology examination of specimens of endometriosis could \ndemonstrated an association of endometriosis with fibrous \nadhesions. [6] \n• Cytology examination of specimens containing endometriosis \nmay be negative for neoplastic features such as glandular \ncomplexity. [6] \nMicroscopic (histologic) description \nThe microscopy pathology examination features of specimens of \nendometriosis had been summated as follows: [6]  \n• At least 2 of the following 3 features should be demonstrated \nupon microscopy pathology examination of specimens of \nendometriosis including: [6]  \no Endometrial type glands \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 4 of 18 \n▪ Müllerian type epithelium (can be atrophic \nto cycling endometrium) \n▪ Can show degenerative atypia (enlarged \nsmudgy nuclei) or metaplasia \no Endometrial type stroma \n▪ Often contains fine capillary network \n▪ May undergo smooth muscle metaplasia, \nfibrosis (longstanding), decidual change \n▪ May be myxoid (particularly in pregnancy) \n▪ Stroma may be the only identifiable \ncomponent (stromal endometriosis) \no Evidence of chronic haemorrhage (hemosiderin laden \nor foamy macrophages) \n• Other rare findings that tend to be found upon microscopy \npathology examination of specimens of endometriosis include \nthe ensuing: [6]  \no Necrotic pseudoxanthomatous nodules: central \nnecrosis surrounded by histiocytes and outer fibrous \nzone. \no Liesegang rings: eosinophilic acellular rings within \nnecrotic tissue. [19]  \no Burnt out endometriosis: this term has been proposed \nfor changes suggestive of endometriosis, such as \ncentral necrosis with surrounding fibrosis and \npseudoxanthoma cells but lacking confirmatory \nfeatures as listed above. [6] \no Atypical endometriosis: this has been reported in 1.7 - \n4.4% of endometriotic lesions and is considered the \nprecursor lesion for endometriosis associated \ncarcinomas (clear cell or endometrioid); may be in \ncontinuity with these tumours. [6] \n▪ Includes crowded glands lined by atypical \nepithelium resembling endometrial atypical \nhyperplasia; nuclear atypia is typically \nmoderate or severe, with hob -nailing. [24] \n[25] [26]  \n▪ Endometriosis is stated to be associated with \nsynchronous / subsequent neoplasia in 25% \nof cases and harbours genomic alterations \nseen in endometriosis associated tumours. \n[26]  \nCytology description \nSome of the cytology descriptions of endometriosis that had been reported \nin various structures had been summated as follows: [6] \n• Cytology examination features of endometriosis had been \nreported within peritoneal fluid and fine needle aspiration of scar \ntissue following gynaecological procedure (for example: in \ncaesarean section specimens) [27]  \n• Variably sized, 3 dimensional spherules with periphery of \npolygonal endometrial cells with larger, hyperchromatic nuclei \nand moderate amount of cytoplasm, often with a centre of \nstromal cells with hyperchromatic nuclei, scant cytoplasm and \nindistinct cytoplasmic borders had been demonstrated in \nspecimens of endometriosis upon cytology examination in some \ntissues. [28]  \n• Cytology examination of specimens containing endometriosis \nmay demonstrate admixed hemosiderin laden macrophages. [6]  \nPositive stains \nIt has been stated that immunohistochemistry staining studies of specimens \nof endometriosis demonstrates positive staining for the ensuing tumour \nmarkers: [6] \n• CD10 is documented or identified to be  is positive in \nendometrial stroma. [6] \n• ER, PR, and PAX2 are documented to be often positive within \nendometrial glands and stroma in cases of endometriosis. [6] \n[29]  \nMolecular / cytogenetics description \nMolecular / cytogenetics features of endometriosis had been summated as \nfollows: [6] \n• Endometriosis and synchronous carcinoma are stated to share \nsimilar genetic alterations \nincluding ARID1A, PTEN and PIK3CA. [6] \n• Mutations in  ARID1A, a tumour suppressor gene, had been \nstated to be identified in up to 57% of ovarian endometrioid \ncarcinoma and up to 30% of clear cell carcinoma. [6] \no Multiple studies had suggested  ARID1A mutation \noccurs at early stage of canceration of endometriosis. \n[30]  \no It had been iterated that endometriosis occurring \ndistant from  ARID1A deficient carcinomas are more \nlikely to retain ARID1A expression. [6] \n• Other associated genetic alterations in cases of endometriosis \nhad been documented to include loss of BAF250a, ER and PR \nand upregulation of hepatocyte nuclear factor - beta and SKP2. \n[6]  \n• It had been pointed out that in one study, loss of DNA mismatch \nrepair protein expression was found in 10% of patients with \nendometriosis associated ovarian carcinoma. [31]  \nDifferential diagnoses \nDifferential diagnoses of endometriosis afflicting some organs had been \nsummated as follows: [6]  \n• Endocervicosis: \no Glandular component is endocervical mucinous type, \nno endometrial stroma, no haemorrhage. [6]  \n• Endosalpingiosis: \no Glandular component is tubal (ciliated with peg / \nintercalated) cells, no endometrial stroma, no \nhaemorrhage. [6] \n• Adenomyosia: [6] \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 5 of 18 \no Endometrial glands and stroma are found within the \nmyometrium \n• Endometrioid adenocarcinoma: [6] \no Complex glandular growth and cytologic atypia \n• Metastatic carcinoma: \no It had been pointed out that the morphology varies by \nsite of origin of the metastatic carcinoma; \nnevertheless, no endometrial stroma is found in cases \nof metastatic carcinoma. [6] \no Other features of neoplasm are noted to be present, \nincluding crowded irregular glands, nuclear atypia or \nelevated mitotic activity. [6]  \n[B] Miscellaneous Narrations And Discussions From Some Case \nReports, Case Series, And Studies Related To Endometriosis Of The \nKidney And Urinary Tract Organs  \n [1] reported a-38-year-old-woman mother of 2 children, who was diagnosed \nto have thyrotoxicosis 3 months earlier and who was on carbimazole. She \nmanifested with abdominal pain of 2 months duration and she was found to \nhave left ovarian mass that measured 15 cm x 12 cm x 6 cm in size. Prior to \nher admission she underwent exploratory laparotomy with bilateral salpingo-\noophorectomy and she was referred to the urology team for further \nmanagement with the surgical specimen. She did not have any menstrual \nirregularities, dysmenorrhea or urinary symptoms. On examination, she was \nfound to be toxic, sick looking, febrile and she had a pulse rate of 102/min, \nblood pressure 110/70 mm Hg, and body mass index of 12.4 kg/m2. She had \na grade II goitre without any pressure symptoms. Her systemic examination \nwas noted to be unremarkable except for the finding of a lower midline scar \nover her abdomen, which was infected with an intra-abdominal swelling. The \nresults of her laboratory test examinations demonstrated a hemoglobin of 11 \ngm/dl, total leukocyte count of 12,000/mm, creatinine 1.33 mg/dl. Her urine \nroutine examination revealed 12 -14 pus cells per high power fields and the \nurine culture grew Escherichia coli. Her T3, T4 and thyrotropin were 2.56 \nng/dl [0.6-1.81], 135 ng/dl (45-109), and 0.04 µIU/ml (0.35-5.5). Her thyroid \nmicrosomal antibody was positive. A 99mTc -scintigraphy of thyroid and \nwhole-body iodine scan demonstrated diffusely increased uptake of tracer in \nthe thyroid bed. A contrast enhanced CT scan of the abdo men was \nundertaken to look for intra -abdominal collections which demonstrated an \nenlarged right kidney with a multiple focal -hypodense lesions of varying \nsizes (5-10 mm) (see Figure 1), and bilateral inflammatory collections in the \nadnexal area. The right ureter and pelvis-caliceal system were dilated up to \nthe lower end. The surgical specimen of ovary and fine needle aspiration \ncytology (FNAC) from hypodense areas of kidney showed evidence of \nendometriosis (Figure 2). She was administered parenteral antibi otics and \nshe underwent pigtail drainage of intraabdominal collection. Subsequently, \nshe received 5 mci of 131I. During her post -operative 6 weeks follow -up \nassessment she was found to be euthyroid. An intravenous pyelography was \nundertaken, and no ureteri c obstruction was identified. Danazol of 400gms \nwere orally administered and she was responding very well. \n \nTable 1: Incidence of extra-genital endometriosis at different sites. Reproduced from [1] Under the Creative Commons Attribution License. \n \n\n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 6 of 18 \nFigure 1: Contrast enhanced Ct scan of the abdomen showing multiple hypodense areas in the right kidney. Reproduced from [1] Under the Creative \nCommons Attribution License. \n \nFigure 2: Photomicrograph showing cluster of tubular epithelial cells in a background containing many scattered foamy histiocytes some of which \ncontain hemosiderin. (hematoxylin & eosin x 360). Reproduced from [1] Under the Creative Commons Attribution License. \n[1] made the ensuing discussing iterations:  \n• Extragenital endometriosis is relatively uncommon.  \n• The lesions may be found within the intestines, urinary tract, \nabdominal scars, thorax, umbilicus, and the kidneys in that order \n(see Table 1). [4]  \n• Genitourinary endometriosis is rare and commonly afflicts the \nfemale between 25 years and 40 years.  \n• It had been stated that urinary bladder is the most site to be \ninvolved followed by ureters, kidney, urethra and prostate \noccurring with a ratio of 40:4:1:1. [5] [32]  \n• Various postulates had been proposed to explain the occurrence \nof endometriosis in the extra genital sites.  \n• Considerable evidence had supported the migratory theory, \nwhich suggests that endometrial tissue elements originate within \nthe uterine mucosa and reach an ectopic position by direct \ninvasion, implantation or metastasis. [33]  \n• More recent evidence had indicated that endometriosis is caused \nby transplantation of viable endometrial fragments which are \nshed during menses that are regurgitated through the fallopian \ntubes due to the influence of prostaglandin mediated uterine \ncontractions. [34  \n• Factors that increase the incidence of endometriosis are stated to \nbe those that cause relative uterine outflow obstruction. This \npostulate could explain the occurrence of renal endometriosis by \nhematogenous metastatic spread. [35] Nevertheless, no such \nfactors were operative in their reported case.  \n• Many clinical observers had indicated that endometriosis is \noestrogen dependent. Any intervention that decreases oestrogen \nproduction typically decreases the extent of endometriosis and \noophorectomy is stated to be usually curative. [36]  \n• Even though, literature review had suggested that renal \nendometriosis is usually associated with previous pelvic \nendometriosis, in their case they were almost concurrent and \ndiagnosed coincidentally during the evaluation of postoperative \nintraabdominal collection.  \n• The other major postulate to explain their case is the coelomic \nmetaplasia theory. During early embryo genesis, coelomic \nmembrane related cells were disintegrated into the developing \nkidneys and subsequently stimulated by increased rate of \nconversion of androgens to oestrogens due to a thyrotoxicosis \nstate.  \n• In thyrotoxicosis, free oestradiol is decreased and its tissue \nmetabolism is increased, which possibly led to silent disease for \na long time in their reported case.  \n• The common manifestations of endometriosis of the kidney are \nlocal pain and rarely cyclical visible haematuria, which is more \ncommon with ureteric and urinary bladder endometriosis. It \nusually comes insidiously and might manifest for many years \nbefore the diagnosis established.  \n• Sometimes the endometriosis lesion may be totally \nasymptomatic as happened in their case.  \n• Many cases in the literature were diagnosed upon histopathology \nexamination of kidneys which were removed for presumed renal \ncell carcinoma. [36] [37] \n• Nevertheless, in view of the wider use of FNAC this type of \nsituation would come down in the future.  \n• Long standing pain from urinary tract and a poor response to \ncommon treatments should raise the possibility of endometriosis \nparticularly in women who have had a history of endometriosis, \nor if the lesions are within the utero -sacral, cardinal ligaments, \nthe ovaries and the pelvic wall. [4] \n•  Literature has been scant and unhelpful for the treatment of \nrenal endometriosis.  \n• The choice of therapy depends upon the condition of kidney, the \nseverity of symptoms, the extent of the disease, the age of the \npatient and whether further pregnancy is planned. [37] \n• Their reported patient has already completed her family, and \nthere was no disturbance of kidney function, a total abdominal \nhysterectomy with bilateral salpingo-oophorectomy had already \nbeen undertaken. Hence, she was put on hormonal manipulation \nwith danazol. The lesions regressed slowly.  \n• During treatment of endometriosis of the kidney, renal function \nshould be closely monitored by clinicians and periodic \nradiology-imaging should be undertaken to look for regression \nof lesions. If ovarian inactivation is insufficient, the disease part \nis usually resected.  \n\n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 7 of 18 \n• Electro coagulation of smaller lesions is not recommended, as \nthe endometrial tissue grows all the way.  \nDutta et al. [1] made the ensuing conclusions: \n• Endometriosis of kidney is a rare manifestation of a common \ndisease.  \n• A high index of suspicion is necessary in order to avoid the \nundertaking of unnecessary nephrectomy.  \nPonticelli et al. [38] made the ensuing iterations:  \n• Little attention had been paid by the renal literature to \nendometriosis of the ureter, which is a rare and silent disorder \nthat could eventually emanate in the development of renal \nfailure.  \n• In endometriosis, the involvement of the ureter could be limited \nto a single ureter, more often the left one, or both ureters with \nconsequent urine tract obstruction and ureterohydronephrosis. \n• In the majority of cases, the ureteric obstruction is caused by \nendometrial tissue encompassing the ureter (extrinsic ureteral \nendometriosis).  \n• In the remaining cases, endometrial cells are located within the \nureter (intrinsic ureteral endometriosis).  \n• Progressive ureteric obstruction of endometriosis could be \ninsidious in onset and could ultimately lead to renal failure if a \ncorrect diagnosis is missed.  \n• The true incidence of renal failure that is caused by \nendometriosis is completely not known, even though cases had \nbeen reported in the literature.  \n• The diagnosis of endometriosis of the ureter is difficult in view \nof the fact the disease may be clinically silent or associated with \nnon-specific symptoms.  \n• Only a high index of suspicion and radiology -image support \nmight help to obtain an early diagnosis. Nevertheless, while \nradiology renal imaging is useful in the cases of extrinsic \nendometriosis, the diagnosis of intrinsic endometriosis often \nrequires the undertaking of ureteroscopy or laparoscopy.  \n• The prognosis of endometriosis of the ureter depends upon the \ntime of diagnosis.  \n• In too many cases of bilateral obstruction, the patient is referred \nto the nephrologist in view of an advanced, irreversible renal \nfailure.  \n• Even though some patients may benefit from progestin or anti -\narotamase therapy, in most cases of ureteric endometriosis \nsurgery is needed, laparoscopy surgery being preferred today to \nlaparotomy. \nNezhat et al. [39] made the ensuing iterations: \n• Ureteral endometriosis, albeit rare, could be complicated by \npotential loss of renal function.  \n• A laparoscopic approach to treatment is based upon the extent of \nthe disease and its localization. \n• Endometriosis of the ureter is a serious localization of disease \nburden which could lead to urinary tract obstruction, with \nsubsequent hydroureter, hydronephrosis, and potential kidney \nloss.  \n• Diagnosis of endometriosis of the ureter is elusive and relies \nheavily upon clinical suspicion as ureteral endometriosis can \noccur with both minimal and extensive disease.  \n• Surgical technique to treatment varies, but the goal is to salvage \nrenal function and decrease disease burden. \nNezhat et al. [39] reported 3 cases of endometriosis of the ureter in which \nthere was documentation of renal atrophy and function loss with subsequent \nworkup and surgical intervention. Nezhat et al. [39] stated that the cases had \nillustrated varying surgic al approaches tailored to localization of ureteral \nendometriosis. All cases were carried out laparoscopically. Nezhat et al. [39] \nmade the ensuing conclusions: \n• Endometriosis of the ureter, albeit rare, could be complicated \nby potential loss of renal function.  \n• Clinical suspicion and pre -operative assessment might help \nwith diagnosis and enables for a multidisciplinary pre -\nconsultation.  \n• Laparoscopic surgical approach is based upon the extent of \nthe disease and localization and could be carried out \nsuccessfully in the hands of a highly experienced \nlaparoscopic surgeon. \nCheng et al. [40] reported a 53 -year-old Chinese premenopausal woman, \nwho had manifested with intermittent right flank pain for many years. She \nhad radiology -imaging studies, which demonstrated a contracted non -\nfunctioning right kidney and a perinephric ab scess. The contracted kidney \nwas adjudged to have resulted from chronic pyelonephritis. The abscess was \ndrained. The patient subsequently underwent a right nephrectomy. \nHistopathology examination of the nephrectomy specimen revealed \nendometriosis of renal parenchyma in addition to xanthogranulomatous \npyelonephritis and a perinephric abscess. No evidence of endometriosis was \nidentified within the pelvic site. The patient was symptom -free pursuant to \nthe operation. Cheng et al. [40] made the ensuing conclusions:  \n• Endometriosis is a common benign condition in women of \nreproductive age which is typified by the presence of \nendometrial glands and stroma outside the uterine cavity, which \nafflicts either genital or extragenital sites.  \n• Involvement of the urinary tract by endometriosis is rare.  \n• Among the urinary tract endometriosis, only a few cases had \nbeen reported to involve the kidney.  \n• Endometriosis of the kidney is difficult to diagnose; a final \ndiagnosis of endometriosis relies upon the histopathology \nexamination findings.  \n• Treatment of endometriosis involves hormonal manipulation or \na hysterectomy with bilateral salpingo-oophorectomy.  \n• Whether a is nephrectomy required depends upon the level of \nrenal function. # \n• Even though extremely rare, renal endometriosis should be part \nof the differential diagnostic spectrum when a contracted, non -\nfunctioning kidney is found.  \n• Early diagnosis might have prevented the undertaking of an \nunnecessary nephrectomy in cases of uncomplicated renal \nendometriosis. \nHorn et al. [41] stated the following: \n• Urinary tract endometriosis is rare and occurs in about 1% of all \nendometriotic lesions.  \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 8 of 18 \n• About 30% of patients suffer from reduced kidney function at \nthe time of diagnosis.  \nHorn et al. [41] reported a 49 -year-old woman, who had manifested with a \nhistory of abdominal hysterectomy without adnexae because of uterus \nmyomatosus without any signs of endometriosis 6 years earlier. She six years \nsubsequently complained of dysuria and  intermittent left loin pain. She had \nultrasound scan and retrograde pyelography which demonstrated incomplete \nureteric obstruction and her scintigraphy demonstrated a partial loss of \nkidney function. Intraoperatively frozen section histology examination a nd \nfinal histopathology examination demonstrated a tumorlike intrinsic form of \nureteral endometriosis engulfing the left ureter. The patient was treated with \nuretero-ureterostomy and danazole for preventing recurrence. She was well \n28 months post-operatively. Horn et al. [41] made the ensuing conclusion: \n• In the extrinsic form (of about 75% of all cases), endometriosis \nof the ureter is localised to the adventitia or surrounding \nconnective tissue of the ureter, whereas the intrinsic form of \nureteral endometriosis is very rare and more often needs \naggressive surgery.  \nChen et al. [42] stated that endometriosis, mainly occurs in female pelvic \norgans and that endometriosis in the kidney is extremely rare. Chen et al. \n[42] reported a case of a 19-year-old girl who had occasional mild abdominal \npain that was associated with  an ectopic left kidney. She had SPECT -CT \nscan which showed no abnormal radioactive distribution in the left pelvis, \nindicating loss of function of the ectopic kidney. Laparoscopic left ectopic \nkidney resection was subsequently undertaken. Histopathology examination \nof the excised specimen revealed endometriosis of the ectopic left kidney. \nChen et al. [42] concluded that: \n• In female patients with clinical manifestations of abdominal pain \nand visible haematuria, the possibility of renal endometriosis \nshould be considered. \nGiambelluca et al. [43] made the ensuing iterations: \n• Endometriosis is a common gynaecological disorder typified by \nectopic endometrial tissue growth outside the uterine cavity.  \n• Even though usually occurring within pelvic organs, endometrial \nlesions might involve the urinary tract.  \n• Endometriosis of the kidney is extremely rare and it has only \noccasionally been reported in the past.  \nGiambelluca et al. [43] reported two cases of patients with renal cystic \nlesions, which were incidentally found by radiology imaging techniques \nduring oncologic follow -up for gastric sarcoma and melanoma, which was \ninitially misinterpreted as complicated h aemorrhagic cysts and then \nhistologically characterized as renal localizations of extragenital \nendometriosis. Giambelluca et al. [43] made the ensuing discussions and \nconclusions:  \n• Their cases were two examples of asymptomatic patients with \nhistory of ovarian endometriosis and incidental detection of \nrenal endometriotic lesions, subsequently histopathological \nexamined.  \n• These patients do not need any therapy for renal lesions being \nasymptomatic and unchanged on the subsequent imaging \nexaminations.  \n• From literature data most of the previously reported examples of \nendometriosis of kidney were found in symptomatic patients. \n• Renal endometriosis is a rare entity which may be asymptomatic \nor clinically controversial and the diagnosis is possible only in \npresence of an appropriate clinicaassessment.  \n• CECT and MR might be helpful in staging the disease process \nand for differential diagnosis from other blood containing \nlesions, even though definitive diagnosis requires histology \nexamination confirmation by identifying endometrial glands and \nstroma within the renal lesions. \nKatsikasos et al. [44] stated that renal endometriosis  is an uncommon \ndisorder of cases of urinary tract endometriosis. Katsikatsos et al. [44] \nreported a-42-year-old woman, who presented at their outpatient department \nwith an incidental painless mass upon her left hypoplastic kidney which was \ndemonstrated on an abdominal ultrasound scan. She had abdominal and \npelvic examinations which revealed no abnormal findings. She had a \ncomputed tomography (CT) scan which showed an anterolateral slightly \nenhanced left renal mass which measured 1.2 cm in diameter. In addition, \nthe CT scan did not reveal any evidence of abdominal or thoracic metastasis. \nKatsikatsos et al. [44] stated also that there were a few case reports in the \nliterature of tumours in specimens from p atients who had undergone \nnephrectomy for hypoplastic kidneys, but discriminating between benign \nand malignant masses is difficult unless a nephrectomy is undertaken. Given \nthe radiological findings and the impaired function of the hypoplastic kidney, \nlaparoscopic radical nephrectomy was recommended. The procedure was \nundertaken under general anaesthesia without intraoperative or postoperative \ncomplications. Microscopy examination of the excised specimen revealed \nmany findings that were consistent with a di agnosis of renal endometriosis. \nThe patient had no symptoms during her last follow -up visit. Katsikatsos et \nal. [44] concluded that: \n• The case had highlighted that renal endometriosis can simulate \nrenal cell carcinoma and awareness of this entity should be \nraised, as it could be asymptomatic, especially when located in a \nhypoplastic kidney. \nHuang et al. [45] undertook a study to determine the risk of chronic kidney \ndisease (CKD) among women with endometriosis in Taiwan. Huang et al. \n[45] undertook a retrospective cohort study using the National Health \nInsurance Research Database of Taiwan. Huang et al. [45] selected a total of \n27,973 women with a diagnosis of endometriosis and 27,973 multivariable -\nmatched controls (1:1) from 2000 to 2010. Huang et al. [45] reported that \nCox regression and computed hazard ratios (HR) with 95% confidence \nintervals (95% CI) were utilised to determine the risk of CKD among women \nwith endometriosis. Huang et al. [45] summated the results as follows:  \n• The incidence rates (IR, per 10,000 person -years) of CKD \namong women with and without endometriosis were 4.64 and \n7.01, respectively, with a significantly decreased risk of CKD \n(crude HR 0.65, 95% CI 0.53 –0.81; adjusted HR 0.69, 95% CI \n0.56–0.86) among women with endometriosis.  \n• The IR of CKD progressively had increased with age, but the \ntrend of lower CKD risk among women with endometriosis was \nfound to be consistent.  \n• Nevertheless, the lower risk of CKD in women with \nendometriosis was no longer statistically significant after \nadjusting for menopausal status (adjusted HR 0.85, 95% CI \n0.65–1.10).  \nHuang et al. [45] made the ensuing conclusions: \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 9 of 18 \n• The results had suggested that endometriosis is inversely \nassociated with CKD, but this effect was mediated by \nmenopause.  \n• The possible mechanism of this association is worthy of further \nevaluation. \nGagnon et al. [46] reported a 27‐year‐old woman, who was known to have a \nsolitary left kidney since the age of 17 years. In her early 20s she was \ninvestigated for recurrent lower abdominal pain that was related to her \nmenstrual periods. At the age of 25 years (in 1997), her pain within the right \ninguinal area was explored surgically, and endometriosis within the \nproximity of the round ligament was found and excised. Her cyclic pelvic \npain was investigated further and a laparoscopy demonstrated endometriosis \nwithin the Douglas pouch. The patient was also known to have a bicornuate \nuterus, which was considered to be a risk factor for endometriosis. While \nwaiting for definitive surgery of pelvic endometriosis (in December 1997), \nshe manifested with recurrent episodes of fever, anorexia, nausea and fatigue \naccompanied by pelvic pain beginning in the middle of her menstrual periods \nand lasting for a few days afterwards. She had noted progressive polyuria \nand nocturia. She came to medical attention in April 1998, d uring a more \nsevere cyclic episode in which she manifested with vomiting and headache. \nShe was found to be severely hypertensive (blood pressure 200/120) with an \nelevated serum creatinine at 201 μmol/l (baseline value of 89 μmol/l in \n1989). An ultrasound w as undertaken which showed hydronephrosis of the \nsolitary left kidney with hydroureter. A retrograde pyelogram was \nundertaken which demonstrated severe obstruction of the distal ureter of the \nsolitary kidney. A double J catheter was advanced with difficulty into the left \nureter through the tight distal stenosis. Her clinical symptoms corrected \nreadily together with improvement in her serum creatinine level. \nAlhindawi et al. [47] made the ensuing iterations:  \n• Ureteral endometriosis commonly manifests with non -specific \nsymptoms or no symptoms.  \n• Diagnostic challenges are multifactorial but they essentially are \ncaused by diagnostic delay due to the silent nature of the disease.  \n• Management of endometriosis of the ureter requires a \nmultidisciplinary approach to optimise the outcome.  \nAlhindawi et al. [47] reported a 29 -year-old woman, who presented with \nsevere deep infiltrating endometriosis resulting in bilateral hydronephrosis \nand loss of left kidney function. She underwent laparoscopic excision of deep \ninfiltrating endometriosis, ur eterolysis, bowel resection and colostomy \nformation. Eventually the left non -functional kidney required \nnephrectomy. Alhindawi et al. [47] made the ensuing conclusions:  \n• The presence of posterior deep infiltrating endometriosis with \nuterosacral involvement should increase clinical suspicion of \nureteral endometriosis and trigger targeted investigations.  \n• The best outcome is achieved by the individualisation of \npatient’s care.   \nCarmignani et al. [48] assessed whether routine renal ultrasound scan may \nbe recommended in all patients with pelvic endometriosis, in order to avoid \nsilent ureteral involvement of the disease. Carmignani et al. [48] undertook \na retrospective descriptive s tudy on seven hundred and fifty patients with a \nprimary diagnosis of endometriosis, between January 2005 and July 2007. \nRoutine urinary ultrasound; recording of patient history, signs, and \nsymptoms; gynecologic examination; blood and urinary analyses; magn etic \nresonance imaging; spiral multi -slice computerized tomography, were \nundertaken. Carmignani et al. [48] summated the results as follows:  \n• Twenty-three patients (3%) of all 750 patients with \nendometriosis had associated ureterohydronephrosis which were \ndiagnosed at renal ultrasound.  \n• Symptoms secondary to ureteric and renal involvement were \npresent in 10 patients (43.5%); 6 patients reported lumbar pain \n(26.1%) and 4 patients (17.4%) had renal colic. \nCarmignani et al. [48] made the ensuing conclusion(s):  \n• In their study, the high number (56.5%) of asymptomatic ureteral \ninvolvement in patients with known pelvic endometriosis \nseemed to warrant the need for further investigations regarding \nthe possibility to avoid the high percentage of silent renal losses.  \n• Unfortunately, there appeared to be no specific risk factor to \nallow for early suspicion nor a validated preventive diagnostic \nand therapeutic program.  \n• It had remained to be evaluated whether urinary ultrasound \nensures a beneficial cost-benefit ratio if undertaken on a routine \nbasis. \nArrieta Bretón et al. [49] reported on the impact that urinary tract \nendometriosis may have on renal function. They stated that ureteral \nendometriosis is an uncommon and a silent cause of renal injury as well as \nthat it is therefore very important to be highly suspicious in order to be able \nto make an early diagnosis and thus prevent renal failure. Arrieta Bretón et \nal. [49] reported on cases documenting on the management and outcome of \nthree cases of premenopausal women with deep endometriosis affecting th e \nureter, associated with secondary unilateral complete loss of renal function. \nArrieta Bretón et al. [49] summated the results with conclusions as follows:  \n• Ureteral involvement by endometriosis is a rare and often silent \ndisease which is capable of producing significant morbidity, as \nit could lead to the development of hydronephrosis and \nultimately to renal failure. \n• Due to the lack of specific symptoms and the limitations of \nradiology-imaging methods, a high index of suspicion is \nnecessary in order to obtain an early diagnosis.  \n• On diagnosis of deep infiltrating endometriosis, urinary tract \nultrasound scan is a screening tool to identify \nureterohydronephrosis due to ureteral obstruction.  \n• MRI scan is of value to map the extent of disease.  \n• Surgery is the therapy of choice to remove endometriotic lesions \nand relieve ureteral obstruction if the kidney is still functional, \nor to undertake a nephrectomy if there is a complete loss of renal \nfunction. \nLangebrekke and Qvigstad [50] made the ensuing iterations:  \n• Ureteral endometriosis is associated with deep endometriosis \nand is relatively uncommon.  \n• In some patients, progressive obstruction of the lower part of the \nureter might develop, with silent loss of kidney function as a \nconsequence.  \nLangebrekke and Qvigstad [50] reported on three patients with loss of renal \nfunction, in whom different pathogenic mechanisms probably were the \ndecisive cause. Langebrekke and Qvigstad [50] stated the following:  \n• Failure to diagnose deep endometriosis with ureteric \ninvolvement, misinterpretation of hydroureter at magnetic \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 10 of 18 \nresonance imaging and lack of typical symptoms could all be \nreasons for development of loss of renal function.  \n• With only one functional kidney, these patients should be \nfollowed-up closely with the undertaking of kidney function \ntests and ultrasound scan, and in certain cases also by magnetic \nresonance imaging scan or renal scintigraphy.  \nYohannes [51] undertook a comprehensive literature review of reports on \nthe diagnosis and management of ureteral endometriosis was performed \nusing MEDLINE. Yohannes [51] summated the results as follows:  \n• Ureteral endometriosis is a rare disease.  \n• Most cases manifest with silent obstruction, as opposed to \ncyclical haematuria.  \n• The diagnosis of endometriosis of the ureter requires a high \nindex of suspicion.  \n• A variety of diagnostic tests could help identify the extent of \ndisease and the degree of renal function on the side of ureteric \ninvolvement. \nYohannes [51] made the ensuing conclusions:  \n• Ureteral endometriosis could be treated with hormones or \nsurgical intervention.  \n• While surgery is reserved for hormone refractory cases and \nobstruction associated with extensive scarring, the majority of \ncases could be managed with hormones only.  \n• A combination of hormones and surgery is also effective.  \n• Surveillance for obstructive uropathy with periodic non-invasive \nmonitoring of renal function is currently recommended for all \npatients with endometriosis. \nPérez et al. [52] undertook a retrospective analysis of 12 cases of urinary \ntract endometriosis diagnosed from 1993 to 2008. Pérez et al. [52] summated \nthe results as follows:  \n• The mean patient age was 37.75 years.  \n• Out of the 12 patients, 5 had urinary bladder involvement and 7 \nhad ureteric involvement, 2 bilateral, 2 left, and 3 right.  \n• In those with urinary bladder endometriosis, the diagnosis was \nmade by cystoscopy and biopsy in 4 patients.  \n• The treatment consisted of laparoscopic hysterectomy and \npartial cystectomy in 1 patient and exploratory laparotomy, \ntrans-vesical resection, and transurethral resection of the bladder \nin 3 patients.  \n• One of the patients who underwent transurethral resection of the \nurinary bladder lesion experienced 2 relapses. The first relapse \nwas treated with transurethral resection of the urinary bladder \nlesion and the second with laparoscopic partial cystectomy.  \n• In the patients with ureteric endometriosis, the diagnosis was \nmainly established by magnetic resonance imaging scan.  \n• The treatment consisted of ureteroneocystostomy in 5 patients \n(bilateral in 1) and laparoscopic ureterolysis in 2, with later \nureteric lesion resection and end -to-end anastomosis in 1 of \nthem.  \n• The patient who underwent bilateral ureteroneocystostomy \nfinally required right auto -transplantation in view of early \nureteral relapses. \nPérez et al. [52] made the ensuing conclusions:  \n• Urinary tract endometriosis is an uncommon pathology finding.  \n• Surgery is the treatment of choice.  \n• They believe partial cystectomy should be considered as an \ninitial option in selected cases, depending upon the extent and \nlocation of lesions.  \n• For cases of endometriosis of the ureter, the initial technique \ndepends upon the location and depth of the lesion.  \nKnabben et al. [53] analysed the prevalence of urinary tract endometriosis \n(UTE) in patients with deep infiltrating endometriosis (DIE) in order to \ndefine potential criteria for preoperative workup. Knabben et al. [53] \nundertook a retrospective study of si x hundred and ninety -seven patients \nwith endometriosis who underwent excision of all endometriotic lesions. \nKnabben et al. [53] undertook a correlation of preoperative features and \nintraoperative findings in patients who had UTE. Knabben et al. [53] \nsummated the result(s) as follows: \n• Out of 213 patients presenting DIE, 52.6% had suffered from \nUTE.  \n• In patients who had ureteric endometriosis, the manifesting \nsymptoms were not specific.  \n• Among the patients with urinary bladder endometriosis, 68.8% \nhad complained of urinary symptoms compared to 7.9% in the \ngroup of patients without UTE.  \n• In patients who had rectovaginal endometriosis, the probability \nof ureterolysis demonstrated a linear correlation with the size of \nthe nodule.  \n• They found that 3  cm in diameter provided a specific cutoff \nvalue for the likelihood of ureteric involvement. \nKnabben et al. [53] made the ensuing conclusion:  \n• The prevalence of UTE had often been underestimated.  \n• Pre-operative questioning is important in the search for \nurinary bladder endometriosis.  \n• The size of the nodule is one of the few reliable criteria in \npreoperative assessment that can suggest ureteric \ninvolvement.  \n• They had proposed a classification of endometriosis of ureter  \nthat would allow the standardization of terminology and help \nto compare the outcome of different surgical treatment in \nrandomized studies. \nBadri et al. [54] made the ensuing iterations:  \n• Endometriosis is a multi -factorial benign disorder which is \ntypified by the abnormal presence of endometrial tissue in an \nextra-endometrial site.  \n• Even though extra -pelvic endometriosis is not common, \nsymptomatic involvement of the kidney is very rare.  \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 11 of 18 \n• This benign disease could simulate many urological processes, \nbut because of its scarcity in clinical practice, it is seldom \nconsidered in the differential diagnosis. \nBadri et al. [54] reported the case of a 45 -year-old woman with flank pain \nand haematuria, who was found to have a left kidney mass on cross-sectional \nimaging. After robotic partial nephrectomy was undertaken, pathology \nanalysis of the specimen revealed an  endometrial implant within the renal \nparenchyma. Badri et al. [54] concluded that:  \n• Their reported case of renal endometriosis had highlighted how \nthis benign disease process could simulate many more sinister \nurologic processes. \nGabriel et al. [55] reported on the prevalence, surgical management, and \noutcome of urinary tract endometriosis (UTE) in a cohort of 221 patients \nwho had undergone laparoscopic surgery for severe endometriosis. They \nstated that UTE can cause significant mo rbidity, such as silent kidney or \nprogressive renal function loss and that its frequency is underestimated and \ndata on laparoscopic management are scarce. Gabriel et al. [55] undertook a \nretrospective study between 2007 and 2010, of 43 patients who were eligible \nfor their single-centre study. The inclusion criterion was the presence of UTE \n(for example urinary bladder and/or ureteric endometriosis). All patients \nwere operated laparoscopically. Gabriel et al. [55] summated the results as \nfollows:  \n• The prevalence of UTE was 19.5% (43/221).  \n• There was no correlation found between urinary bladder and \nureteral endometriosis (P >.05).  \n• Endometriosis of ureter was associated with patient's age (P \n<.01).  \n• Patients who had urinary bladder, but not ureteral, involvement \ncomplained more frequently about dysuria, visible haematuria, \nand urinary tract infections. \n• Intraoperative and magnetic resonance imaging (MRI) scan \nfindings demonstrated a moderate to good correlation.  \n• UTE was not associated with rectovaginal or bowel \nendometriosis, but rather with the involvement of the uterosacral \nligaments (P <.01).  \n• Twenty-two patients with endometriosis of the urinary bladder \nwere treated by mucosal skinning and 11 patients underwent \npartial cystectomy.  \n• Superficial ureteral excision was undertaken in 4 patients, \nwhereas resection with ureteroureterostomy was undertaken in 9 \npatients.  \n• There was no difference regarding the intra - and postoperative \ncomplications in patients with or without UTE. \nGabriel et al. [55] made the ensuing conclusions: \n• In severe pelvic endometriosis, involvement of the urinary tract \nis quite common.  \n• Laparoscopic management is feasible and safe.  \n• In view of the lack of specific symptoms, the pre -operative \ndiagnosis of ureteral endometriosis still has remained a \nchallenge.  \n• Pelvic MRI scan represents a useful preoperative diagnostic tool.  \nMuthuppalaniappan et al. [56] reported a case of a 30 -year-old female, who \nhad a background history of SLE with a silent progressive kidney injury due \nto an obstructive uropathy secondary to bilateral intrinsic UE and severe loss \nof her left kidney functio n that was treated with ureteric stenting. She \nsubsequently underwent bilateral re -implantation of her ureters as a \ndefinitive treatment plan as she had expressed a desire to conceive. \nMuthuppalaniappan et al. [56] made the ensuing discussing iterations: \n• Progressive renal injury as a result of UE had been reported in \nthe past; nevertheless, its true incidence is not known.  \n• The time of diagnosis is crucial as it does reflect renal prognosis.  \n• They had outlined in their article the clinical implications from \nthe renal perspective of the disease considering the relevant \nhealth problem UE can impose to women.  \n• Their paper had discussed the emerging evidence of an \nassociation between SLE and endometriosis which had remained \npoorly understood. \nMuthuppalaniappan et al. [56] made the ensuing conclusions:  \n• A high index of suspicion is required to diagnose UE as the \ndisease occurs insidiously with non -specific manifesting \nsymptoms leading to a silent obstructive uropathy.  \n• If the diagnosis is missed it could ultimately lead to irreversible \nkidney dysfunction and mortality.  \n• They had suggested that patients with endometriosis especially \nUE should be followed up regularly with renal function testing \nand imaging.  \n• Any health professionals who are dealing with patients suffering \nfrom SLE should consider appropriate investigations and referral \nif any symptom that indicates endometriosis is reported. \nVrettos et al. [57] made the ensuing iterations:  \n• Endometriosis is stated to be a common disorder which afflicts \n5% to 10% of women of reproductive age, for which the gold \nstandard investigation for the diagnosis is laparoscopy and \nbiopsy with histological confirmation. [58] [59]  \n• Urinary tract endometriosis occurs in about 1% of women with \npelvic endometriosis. [60] \n• Endometriosis involves the ureters, it could manifest with renal \ncolic and can cause hydronephrosis and renal complications due \nto obstruction, mainly in women of child-bearing age.  \n• The manifesting symptoms could be non-specific.  \n• Delayed diagnosis could lead to the development of kidney \nfailure due to silent obstruction of the ureter. [61]  \n [57] reported a case of a 43 -year-old lady who manifested with recurrent \nepisodes of right-sided colicky abdominal pain. She manifested with severe, \nright-sided colicky abdominal and right loin pain which radiated to the right \ngroin. She reported similar episodes of pain previously, but no clear \ndiagnosis had been established. Her primary care physician had treated her \nconservatively for possible kidney stones, even though there was no \nradiology-image evidence to support that. Upon examination, she was found \nto be afebrile and her vital signs were stable. Her blood results demonstrated \na mild elevation in her urea and creatinine levels. She had a computed \ntomography scan of the kidneys-ureter-bladder (CT KUB), which showed a \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 12 of 18 \nmoderate degree of right sided hydronephrosis but no stone was identified \n(see figure 3). An intravenous urogram (IVU) was undertaken which \ndemonstrated marked distension of the right pelvic calyceal system and \nnarrowing of the right distal ureter (see fig ure 3). The patient then \nsubsequently had a magnetic resonance imaging (MRI) scan which \ndemonstrated abnormal soft tissue thickening within the right adnexal \nregion, but no clear cause of the ureteric obstruction was demonstrated (see \nfigure 4). She then u nderwent laparoscopy to ascertain the nature of the \npathology and to provide tissue diagnosis. The pathology findings \ndemonstrated elements of endometrial tissue which had encased the distal \nureter. In view of the proximity of the ureteric stenosis to the ureterovesical \njunction, the patient was treated by means of an open ureterocystoneostomy. \nShe had an uncomplicated course and her pain resolved after the operation. \nShe did not experience any further episodes of pain. She had been followed \nup as an outpat ient regularly with monitoring of her renal function, which \nhad remained normal and stable. \n \nFigure 3: Computed tomography scan of the kidneys-ureter-bladder (CT KUB) demonstrating right sided hydronephrosis (arrow). Intravenous \nurogram (IVU) showing narrowing of the right distal ureter (arrowhead). Reproduced from [57] Under the Creative Commons Attribution License. \n \nFigure 4: Magnetic resonance imaging (MRI) scan of the pelvis showing abnormal tissue (arrowhead) which encases the right distal ureter  (arrow). \nReproduced from: [57] Under the Creative Commons Attribution License.  \n [57] made the ensuing discussions and conclusions:  \n• Their case had highlighted an uncommon yet important cause of \nureteric stricture which could even lead to loss of kidney \nfunction. [62] \n• The diagnosis relies heavily upon clinical suspicion and \ndefinitive treatment might be difficult to be achieved.  \n• Magnetic resonance imaging scan is a useful pre -operative tool \nfor the diagnosis and assessment of ureteral endometriosis. [63] \n• It is important that this underdiagnosed condition, which might \nultimately lead to renal failure, be diagnosed as early as possible. \n• Then every effort needs to be made in order to restore and \npreserve kidney function. [64] \n• In patients who have hydronephrosis and the localization of the \nureteric stenosis close to the vesicoureteral junction, the \nappropriate procedure is a ureterocystoneostomy, which is \ntypically undertaken through an open technique. [65] \n• The laparoscopic procedure had also been successful in the \ntreatment of distal ureteric stenosis. [66]  \n [67] made the ensuing iterations:  \n• Endometriosis of the kidney is a rare disease for which the \nmechanisms of pathogenesis are still unclear.  \n• In view of this, early diagnosis and an appropriate treatment are \noften delayed because of the tendency to be misdiagnosed as a \nrenal tumour.  \n• In October 2013 they undertook a radical nephrectomy for a 37-\nyear-old woman with renal endometriosis who was \npreoperatively misdiagnosed as having a right renal tumour.  \n• Avoiding the misdiagnosis of renal endometriosis entails a \ndetailed case history taking, especially regarding whether the \ncyclicity of lumbodorsal pain and haematuria correlates with \npatients' menstrual cycles.  \n• Radiology imaging examinations are commonly helpful for \nlocalization, whereas relieving symptoms with medicaments to \ncreate a hypoestrogenic state is useful for clinical diagnosis.  \n• Nevertheless, a final diagnosis for renal endometriosis still \nshould depend upon histopathologic examination.  \n \n [68] made the ensuing iterations:  \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 13 of 18 \n• Ureteral endometriosis is estimated to occur in about 0.08% to \n1% of patients with endometriosis.  \n• The serious condition, may lead silently to obstruction of the \nurinary tract leading to hydronephrosis, hydroureter and \npotential loss of kidney function.  \n• Endometriosis of the ureter is often associated with \nendometriomas, deeply infiltrating endometriosis, and the \ninvolvement of uterosacral ligaments.  \n• Diagnosis of endometriosis is often challenging due to the silent \nnature of the disease and the presence of non -specific or no \nsymptoms.  \nNagar et al. [68] reported a 30 years old healthy woman, who was admitted \ndue to abdominal pain lasting for 5 days without fever. She complained of \ndysmenorrhea but no other gynaecological, urinary or digestive symptoms. \nShe had trans vaginal + abdominal u ltrasound (US) of a left ovarian \nunilocular cyst that measured 85*83*123mm with “ground glass” content, \nwhich was suspected for endometrioma. Severe hydronephrosis of left \nkidney with dilated calyx and cortical thinning, pelvic tubular structure \n30*18 with clear fluid was suspected for dilated left hydroureter. Under \nradiology-imaging limitations there were no signs of DIE CT \nUROGRAPHY was undertaken which confirmed the urinary system \nfindings. Her laboratory test serum creatinine was 0.79, the results of h er \nelectrolytes were normal. Surgery (laparoscopy) drainage of 10cm left \nendometrioma, left salpingectomy due to LT hydrosalpinx, removal of \n4cm deep infiltrating endometriotic nodule that involved the left ureter, left \nuterine artery and left infundibulo -pelvic ligament was and left were \nnephroureterectomy undertaken. \n[68] made the ensuing conclusions: \n• Non-specific symptoms and incorrect diagnosis of ureteral \nendometriosis could lead to renal damage as a result of \nprolonged hydronephrosis.  \n• In view of this, in routine targeted ultrasound scan for \nendometriosis, radiology-imaging of the kidneys should form an \nintegral part of assessment.  \n• Physicians should suspect endometriosis of the ureter in \nreproductive age women with unilateral or bilateral distal \nureteral obstruction of uncertain cause.  \n• A high index of suspicion and utilisation of imaging modalities \nenable earlier diagnosis, preservation of renal function, and \nimproved prognosis. \n [69] presented data from 18 cases of ureteral endometriosis. They \nundertook Prospective clinical study of four hundred and five patients with \nsevere dysmenorrhea or deep dyspareunia due to a rectovaginal \nendometriotic (adenomyotic) nodule. The patients we re prospectively \nevaluated using intravenous pyelography. All of the patients underwent \nlaparoscopic surgery to remove rectovaginal adenomyosis and \nureterolysis. The main outcome measure included presurgical and \npostsurgical evaluation and histological ana lysis.[69] summated the \nresult(s) as follows:  \n• Preoperative intravenous pyelography revealed ureteral stenosis \nwith ureterohydronephrosis in 18 patients (4.4%).  \n• A significantly higher prevalence (11.2%) was observed in \nnodules ≥ 3 cm in diameter.  \n• Five women (20%) were found to have kidney parenchymal \nfunction, which ranged from 18% to 42%.  \n• Laparoscopic ureterolysis was undertaken in 16 women; 2 \nwomen underwent ureteral resection and uretero-ureterostomy.  \n• A significant postoperative decrease in ureterohydronephrosis \nwas identified noted in all patients; nevertheless, renal function \nimproved only slightly.  \nThey made the ensuing conclusion(s):  \n• Ureteral endometriosis was found in 4.4% of patients with \nrectovaginal endometriotic (adenomyotic) nodules.  \n• Ureterolysis and removal of associated adenomyctic lesions was \nsufficient therapy in most patients; two required resections of the \nureteric stenotic segment.  \n• Intravenous pyelography should be performed in all women with \nrectovaginal nodules ≥ 3 cm to prevent non -reversible loss of \nrenal function. \n[70] reported a -29-year-old woman, who manifested with unilateral loin \npain because of severely hydro-nephrotic kidney due to deposits of pelvic \nendometriosis. Double J-stent was inserted beyond the obstruction and she \nwas commenced on hormone therapy. The  stent was removed after three \nmonths when her back pressure changes had resolved. Gupta et al. [70] \nconcluded that the case was presented along with a short relevant \ndiscussion, due to rarity of ureteral involvement by endometriosis. \n [71] reported a 42 -year-old woman, who was referred to their hospital \nbecause of abdominal fullness and a large abdominal mass and other \nsymptoms. She had computed tomography (CT) scan and retrograde \npyelography (RP) which revealed left hydronephrosis and  a filling defect \nin the left lower ureter. Based on the diagnoses of endometriosis of \nbilateral ovaries, uterine myoma and a left ureteral tumour, abdominal total \nhysterectomy, right salpingo-oophorectomy and partial ureterectomy were \nundertaken. Patholog ically, within the uterus, both leiomyoma and \nadenomyosis, and endometriosis of the right ovary and ureter were \ndiagnosed. Medication with buserelin acetate was commenced.   \n [72] stated that deep endometriosis (DE) could be more aggressive than \nother-types of endometrioses, and might even lead to irreversible severe \ncomplications such as complete unilateral loss of kidney function. \nMartinez-Zamora et al. [72] described the cl inical and radiology -image \ncharacteristics of DE patients who were diagnosed with irreversible \nunilateral loss of renal function due to unilateral ureteral stenosis and they \nevaluated risk factors for developing this loss. The study of Martinez -\nZamora et a l. [72] was a retrospective cohort study, which included 436 \npatients who underwent laparoscopic DE surgery. Martinez -Zamora et al. \n[72] evaluated two groups of patients according to preserved (Non -Renal \nLoss Group; n = 421) or irreversible unilateral dama ged renal function \n(Renal Loss Group; n = 15). They collected pre -operative epidemiologic \nvariables, clinical characteristics, radiologic findings and surgical \ntreatments of all the patients. They found that the Renal Loss Group had a \nhigher infertility ra te and a higher proportion of asymptomatic patients. \nThe following radiology image variables showed statistically significant \ndifferences between the two groups: mean endometrioma diameter, the \npresence of intestinal DE and negative sliding sign. Multivari ate analysis \nshowed that infertility, being asymptomatic, having intestinal DE or torus \nuterinus/uterosacral ligament DE and a negative sliding sign significantly \nincreased the risk of loss of renal function. Martinez -Zamora et al. [72] \nconcluded that:  \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 14 of 18 \n• Among patients with these clinical and/or radiological variables, \nsevere urinary tract obstruction should be specifically excluded.  \n [73] reported a patient who underwent laparoscopic endometriosis \nresection with right ureterolysis, left nephrectomy, left salpingo -\noophorectomy, lysis of adhesions. Nephrectomy and contralateral \nureterolysis and dissection of pelvic spaces for successful  resection of \nendometriosis and maintenance of solitary ureter patency was undertaken \nin order to preserve remaining kidney function. Colussi et al. [73] made \nthe ensuing conclusions:  \n• Renal function and structure should be regularly evaluated in \npatients who are afflicted by deep infiltrating endometriosis.  \n• Surgical intervention, with complete resection of endometriosis, \nis the optimal approach for prevention of recurrence of ureteral \nendometriosis. \n[74] made the ensuing iterations:  \n• Endometriosis is a benign condition afflicting up to 10% of \nwomen at reproductive age.  \n• The urinary tract is affected in 0.3% to 12.0% of women with \nendometriosis and in 19.0% to 53.0% of women with deep \ninfiltrating endometriosis.  \n• The urinary bladder is the most commonly affected organ in the \nurinary tract.  \n• Urinary bladder endometriosis is defined by the presence of \nendometriosis lesions within the detrusor muscle, with partial or \ncomplete thickness involvement.  \n[74] undertook a retrospective study. The study analysed surgical reports \nof 11,714 patients who underwent endometriosis laparoscopy, and \nincluded only 42 patients with urinary bladder endometriosis. Piriyev et al. \n[74] summated the results as follows:  \n• They found that 0.35% of patients with endometriosis had \nbladder endometriosis.  \n• In total, 29 patients underwent telephone phone follow-up.  \n• In total, 26 patients (90%) had reported a general improvement \nin their symptoms (for example, improving the dysmenorrhea, \nlower abdominal pain), with a 100% improvement in their \ndysuria.  \n• Only two patients (7%) reported no change in their symptoms \n(dysmenorrhea and dyspareunia).  \n[74] made the ensuing conclusions:  \n• Gynaecologists can undertake laparoscopic surgical treatment of \nurinary bladder endometriosis in most cases.  \n• If ureteroneocystostomy is required or the localization of the \nendometriosis nodule is unfavourable, an intervention by an \ninterdisciplinary team is recommended.  \n• Both laparoscopic partial bladder resection and shaving could be \nconsidered to be effective methods with low complication risk.  \n• This surgical approach requires excellent laparoscopic skills. \n[75] made the ensuing iterations:  \n• Abdominal wall endometriosis (AWE) consists of endometrial \ntissue between the peritoneum and the abdominal wall. \n• The established treatment involves amenorrheic medicaments \nwhich are not always successful and tolerated, or invasive \nsurgery.  \n• In this scenario, minimally invasive techniques such as \ncryoablation are a potential option. \n• They had undertaken a study, with the aim of evaluating the \nefficacy of percutaneous cryoablation in reducing pain scores of \nAWE patients and they had analysed their satisfaction with the \nprocedure and its related adverse events. \n[75] systematically searched MEDLINE, EMBASE, and Cochrane’s \ndatabases for studies that employed percutaneous cryoablation therapy for \nAWE and reported any of the outcomes of interest. The primary outcome \nwas the reduction in the visual analogue scale (VAS ) score after treatment. \nR Software was used for the statistical analysis. Heterogeneity was assessed \nusing I statistics. They assessed the risk of bias in non-randomized studies of \ninterventions framework for potential bias in each selected study. Kaça do  \nCarmo et al. [75] summated the results as follows:  \n• They included 4 studies, containing 126 patients.  \n• All articles were retrospective studies.  \n• The difference between the VAS scores before and after \ntreatment was on average 5.97 points (95% CI 5.42 -\n6.52; P <.01; I2 = 0%).  \n• The pooled satisfaction rate among patients in the selected \nstudies was 93.1% (95% CI 88.66-97.34; P = .51; I2 = 0%).  \n• The pooled prevalence of adverse events was only 5.48% \n(95% CI 1.71-11.20; P = .58; I2 = 0%). \n• Bias analysis revealed an overall moderate risk in all \nincluded articles. \n [75] made the ensuing conclusions and declaration of advances in \nknowledge:  \n• Their study had demonstrated that cryoablation could reduce \npain complaints in patients, while presenting a low incidence rate \nof adverse effects.  \n• Randomized clinical trials with a larger number of patients are \nneeded for greater conclusions. \n• AWE affects about 3.5% of women.  \n• The standard treatment is invasive surgery. \n•  This meta -analysis had shown that cryoablation could \neffectively reduce pain scores while presenting a low rate of \nadverse effects.  \n• Cryoablation is a feasible treatment for AWE, furthermore \nenabling shorter hospital stays and few complications for the \npatients. \n[76] undertook a study to evaluate the efficacy of percutaneous cryoablation \nin the treatment of abdominal wall endometriosis (AWE) nodules. Bachour \net al. [76] retrospectively included thirty-eight women, who were treated for \nsymptomatic AWE nodules with percutaneous cryoablation under \nultrasound and computed tomography (CT) guidance between May 2020 and \nJuly 2023. Pain was estimated using visual analog scale (VAS) and assessed \nat baseline, three months, six months, and 12 months after percutaneous \ncryoablation. Baseline VAS score, volume of AWE nodule and magnetic \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 15 of 18 \nresonance imaging (MRI) features of AWE nodules were compared to those \nobtained after percutaneous cryoablation. Major complications, if any, were \nnoted. Bachour et al. [76] summated the results as follows:  \n• Thirty-eight women who had a median age of 35.5 years \n(interquartile range [IQR]: 32, 39; range: 24 –48 years) and a \ntotal of 60 AWE nodules were treated.  \n• Percutaneous cryoablation was undertaken under local or \nregional anaesthesia in 30 women (30/38; 79%).  \n• Significant decreases between initial median VAS score (7; IQR: \n6, 8; range: 3–10) and median VAS score after treatment at three \nmonths (0; IQR: 0, 5; range; 0 –8) (P < 0.001), six months (0; \nIQR: 0, 1; range; 0–10) (P < 0.001) and 12 months (0; IQR: 0, 2; \nrange: 0–7) (P < 0.001) were found.  \n• Percutaneous cryoablation resulted in effective pain relief in 31 \nout of 38 women (82%) at six months and 15 out of 18 women \n(83%) at 12 months.  \n• Contrast-enhanced MRI during six -month follow -up \ndemonstrated a significant decrease in the volume of AWE \nnodules and the absence of AWE nodule enhancement after \ntreatment by comparison with baseline MRI (P < 0.001). No \nmajor complications were reported. \nBachour et al. [76] concluded that:  \n• Percutaneous cryoablation is an efficacious, minimally \ninvasive intervention for the treatment of AWE nodules that \nconveys minimal or no morbidity. \nConclusions  \n• Endometriosis of the kidney and urinary tract organs is an \nuncommon affliction which manifests with non -specific \nsymptoms and signs that simulate the manifestations of more \ncommon afflictions of the kidney and urinary tract organs.  \n• Diagnosis of endometriosis of the kidney and urinary tract \norgans requires a high index of suspicion and pathology \nexamination of specimens of the lesions.  \n• Even though most often endometriosis of the kidney and urinary \ntract organs had tended to be treated with analgesia to control \npain as well as medicaments including hormonal treatment, \ndefinite treatment in a number of scenarios had required \ncomplete surgical excision of the lesion; nevertheless, pursuant \nto the development of minimal invasive surgery, alternative \nprocedures could be used in the first instance to treat \nendometriosis of the kidney and urinary tract organs which \ninclude: cryotherapy of the lesion, radiofrequency ablation of the \nlesion, irreversible electroporation of the lesion, thermotherapy \nof the lesion, as well as selective angiography and super -\nselective embolization of the branch of artery supplying the \nlesion, pursuant to confirmation o f the biopsy based upon \npathology examination of the lesion. \n• In the scenario of obstructed ureter and hydronephrosis, the \ninitial management to improve or maintain renal function may \nentail the undertaking of per -cutaneous nephrostomy or \ncystoscopy, retrograde ureteropyelogram, ureteroscopy and \ninsertion of double J  ureteric stent to obviate the ureteric \nobstruction to enable good drainage of urine.  \n• Even though some individuals who are afflicted by \nendometriosis may manifest with a number of symptoms \nincluding infertility, endometriosis may not be the actual cause \nof infertility.  \n• It is important for all clinicians to appreciate the fact that female \nfactor infertility may account for 40% of cases, male factor \ninfertility may account for 40% of cases and 20% of cases may \nbe attributed to a combination of male and female infertility \nfactors. In view of this if a lady with endometriosis manifests \nwith infertility, both the lady and her spouse should be fully \ninvestigated to ascertain the cause of the infertility in order to \nprovide excellent management of each case.     \nConflict Of Interest – Nil \nAcknowledgements \nAcknowledgements to:  \n• Saudi Medical Journal, for granting permission for reproduction \nof figures and contents of their journal article under the Creative \nCommons Attribution License under the ensuing copyright \niterations: © 2025 Saudi Medical Journal Saudi Medical Journal \nis copyright under the Berne Convention and the International \nCopyright Convention.   Saudi Medical Journal is an Open \nAccess journal and articles published are distributed under the \nterms of the Creative Commons Attribution -Non-Commercial \nLicense (CC BY-NC). Readers may copy, distribute, and display \nthe work for non -commercial purposes with the proper citation \nof the original work. Electronic ISSN 1658 -3175. Print ISSN \n0379-5284. \n• Quantitative Imaging in Medicine and Surgery, for granting \npermission for reproduction of contents of their journal article \nunder the Creative Commons Attribution License under the \nensuing copyright iteration:  CC BY -NC-ND 4.0 \nATTRIBUTION-NONCOMMERCIAL-NODERIVATIVES \n4.0 INTERNATIONAL DEED.  \nReferences   \n1. Dutta P, Bhat MH, Bhansali A, Kumar V (2006). A young \nwoman with endometriosis of kidney. Saudi medical journal . \nFeb 1;27(2):244.  \n2. Scully RE, Mark EJ, McNeely WF, Mc Neely BU (1997). \nWeekly clinicopathological exercises. Case 33-1992. A 34 year \nold woman with endometriosis and bilateral hydronephrosis. N \nEngl J Med ; 336: 481-485. \n3. Stanley KE, Utz DC, Dockerty MB (1965). Clinically significant \nendometriosis of the urinary tract. Surg Gynecol Obstet  ; 120: \n492-498.  \n4. Bergqvist A. Extra-genital endometriosis: A review (1943). Eur \nJ Surg 1992; 158: 7 -12. 4. Marshall VF. 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Kaça do Carmo LH, Brito Ceolin de Faria S, Cruz Fagundes MD, \nCosta de Oliveira Lima L, Verdan Moreira S, et.al (2025). \nPercutaneous Cryoablation Therapy for Abdominal wall \nEndometriosis: a Systematic Review and Meta-analysis. British \nJournal of Radiology. Jan 16: tqaf009.  \n76. Bachour R, Sengmanivong N, Vidal F, Goumarre C, Lapègue F, \net.al (2024).Percutaneous cryoablation of abdominal wall \nendometriosis: An analysis of 38 patients, Diagnostic and \nInterventional Imaging; 105(9): 319-325. \n\nClinical Medical Reviews and Reports                                                                                                                                                  Copy rights@ Anthony Kodzo-Grey Venyo, \nAuctores Publishing LLC – Volume 7(2)-254 www.auctoresonline.org  \nISSN: 2690-8794   Page 18 of 18 \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n This work is licensed under Creative    \n   Commons Attribution 4.0 License \n \n \nTo Submit Your Article Click Here: Submit Manuscript \n \nDOI:10.31579/2690-8794/254\n \n \n \nReady to submit your research? 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