{"paper_id":"efdeacfb-ab90-47ba-b1df-5f26bdeb6b65","body_text":"Abstract\nBackground\nUreteral endometriosis is a rare but potentially severe manifestation of DIE, which may lead to hydroureteronephrosis and irreversible renal impairment. This study aimed to characterize the clinical and surgical features of UE in DIE and to identify factors associated with ureteral involvement and hydroureteronephrosis.\nMethods\nThis retrospective study was conducted at the Department of Gynecologic Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine. A total of 838 patients with histologically confirmed DIE were included in this study between January 2014 and November 2025.\nResults\nAmong 838 patients with DIE, 171 (20.4%) were diagnosed with UE. UE was predominantly unilateral (n = 143, 83.6%), with left-sided involvement in 83 patients (48.5%) and right-sided in 60 patients (35.1%). Multivariate logistic regression analysis identified age (OR = 1.04, 95% CI 1.01–1.07, p = 0.002), history of endometriosis-related surgery (OR = 1.71, 95% CI 1.13–2.57, p = 0.011), low back soreness (OR = 3.86, 95% CI 2.39–6.24, p < 0.001), urinary frequency (OR = 4.27, 95% CI 1.84–9.92, p < 0.001), uterosacral ligament nodules (OR = 1.75, 95% CI 1.19–2.59, p = 0.005) and rectovaginal septum nodules (OR = 3.25, 95% CI 1.15–9.16, p = 0.026) as factors independently associated with UE. A significantly higher proportion of patients in the UE group had a history of endometriosis-related surgery compared with the non-UE group (30.4% vs. 18.6%, p < 0.001). Hydroureteronephrosis was present in 45% of patients with UE. Intrinsic UE accounted for 8.8% of cases and was more frequent among patients with hydroureteronephrosis than among those without (18.2% vs. 1.1%, P < 0.001). Hydroureteronephrosis was also associated with longer operative times and postoperative hospital stays. Among the 40 patients who underwent renal scintigraphy, 22 (55%) patients had moderate-to-severe impairment of differential renal function in the hydroureteronephrotic kidney, and 7 (17.5%) patients had a nonfunctioning kidney.\nConclusions\nUreteral endometriosis was frequently observed in this selected surgical DIE cohort and was frequently associated with hydroureteronephrosis and renal impairment. Given that symptoms may remain subtle even in the presence of hydroureteronephrosis, reliance on clinical presentation alone is insufficient for early detection. Therefore, early recognition requires integration of clinical features, imaging, and multidisciplinary management to enable timely diagnosis and prevent irreversible renal damage.\nSimilar content being viewed by others\nAbbreviations\n- AUC:\n-\nArea under curve\n- BMI:\n-\nBody Mass Index\n- CTU:\n-\nComputed Tomography Urography\n- DIE:\n-\nDeep Infiltrating Endometriosis\n- GnRH-a:\n-\nGonadotropin-releasing Hormone Agonist\n- IQR:\n-\nInterquartile Range\n- LRT:\n-\nLikelihood Ratio Tests\n- Mirena IUD:\n-\nLevonorgestrel-releasing Intrauterine System\n- MRI:\n-\nMagnetic Resonance Imaging\n- MRU:\n-\nMagnetic Resonance Urography\n- OR:\n-\nOdds Ratio\n- rASRM:\n-\nrevised American Society for Reproductive Medicine\n- UE:\n-\nUreteral endometriosis\n- UTE:\n-\nUrinary tract endometriosis\n- VIFs:\n-\nVariance inflation factors\n- vNOTES:\n-\nTransvaginal Natural Orifice Transluminal Endoscopic surgery\nAcknowledgements\nNone.\nFunding\nThis research was funded by the Fundamental Research Funds for the Central Universities (project number YG2024ZD06), National Natural Science Foundation of China (project number 82371652) and Beijing Science and Technology Innovation Medical Development Foundation (project number KC2023-JX-0186-RM071).\nAuthor information\nAuthors and Affiliations\nCorresponding authors\nEthics declarations\nEthics approval and consent to participate\nThe study was approved by the Ethics Committee of Renji Hospital (approval number: LY2026-149-A). All included patients provided written informed consent. All procedures complied with the Declaration of Helsinki and institutional standards.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.\nAbout this article\nCite this article\nHu, Z., Zhao, X., Gu, Y. et al. Clinical characteristics of ureteral endometriosis in patients with deep infiltrating endometriosis: a retrospective cohort study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-05028-3\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-05028-3","source_license":"CC0","license_restricted":false}