Diagnosis and treatment of ureteral endometriosis ( report of 12 cases)

Objective To improve the diagnosis and treatment of ureteral endometriosis. Methods The clinical data of 12 women (age range,29 -59 years) with ureteral endometriosis were analyzed retrospectively. The clinical presentations included flank pain or lower abdomen pain in 9 cases, menstrual disorder in 1 ,and previous dysmenorrhea in 8. B-ultrasound indicated unilateral upper urinary tract dilation and hydrops in all cases,with pyelic separation from 26 to 52 mm. IVU showed poor image in 5 cases and u-nilateral upper urinary tract dilation and hydrops in 7. Preoperatively,7 cases underwent bilateral renal ECT scan,which showed that the glomerular Filtration rates ( GFR) of the diseased kidneys were lower than normal. Of the 7 cases, 1 had GFR 10 ml/min and 1 had giant hydronephrosis without renal function. Re-Slilts Of the 12 cases, 11 were treated surgically. Postoperative pathological findings confirmed the diagnosis of ureteral endometriosis. The ectopic endometria were all located at the lower ureter. One case was treated with hormonotherapy. All 12 cases were followed for 3 - 110 months. One case had recurrent hydronephrosis in 19 months postoperatively. This case received ureteral stent and cured by goserelin subcutaneous injection for 6 months. The other 11 cases underwent regular B-ultrasound and had no recurrence. Conclusions Most cases of ureteral endometriosis present with silent urinary obstruction. The diagnosis of ureteral endometriosis relies on imaging and ureteroscopic techniques. The goal of therapy of ureteral endometriosis is to relieve obstruction, eliminate symptoms and preserve renal function. The management of ureteral endometriosis depends on the extent of the disease,desire of preserving fertility and renal function. The treatment options include hormonotherapy and a variety of surgical approaches with good prognosis.