The Silent Kidney—Unmasking the Urinary Tract Involvement in Endometriosis—An Observational Study at a Tertiary Care Hospital

Background Urinary tract endometriosis (UTE) is a rare manifestation of deep infiltrating endometriosis (DIE) and is often underdiagnosed due to nonspecific or absent urinary symptoms. Delayed recognition may result in progressive ureteric obstruction and silent renal function loss. This study aimed to evaluate the incidence, clinical presentation, imaging findings, surgical management, and outcomes of patients with UTE managed at a tertiary referral center.

A retrospective observational study was conducted at GEM Hospital, Coimbatore, between January 2020 and December 2025. Among 496 women evaluated for endometriosis, 12 patients diagnosed with UTE were included. Demographic details, clinical features, magnetic resonance imaging (MRI) findings, intraoperative observations, surgical procedures, and postoperative outcomes were analyzed. Surgical management was individualized and included laparoscopic ureterolysis, ureteric stenting or reimplantation, bladder lesion excision, or segmental bladder resection.

The mean age was 38.75 ± 6.29 years. Ureteric involvement was observed in seven patients (58%) and bladder involvement in five (42%). Dysmenorrhea was the most common symptom (66%), while one patient was asymptomatic. MRI identified hydroureteronephrosis in all ureteric cases, predominantly due to extrinsic compression. Laparoscopic ureterolysis successfully relieved obstruction in most patients. Definitive surgery was performed in nine patients, while fertility-preserving procedures were done in three. All patients were symptom-free at follow-up, with no major complications.

UTE, though rare, carries a significant risk of silent renal damage. Early clinical suspicion, MRI-based evaluation, and timely multidisciplinary laparoscopic management are crucial for renal preservation and favorable outcomes. Similar content being viewed by others Abbreviations - DIE: - Deep infiltrating Endometriosis - UTE: - Urinary tract endometriosis - MRI: - Magnetic resonance imaging - HUN: - Hydronephrosis/hydroureteronephrosis - DTPA: - Dynamic renal scintigraphy using technetium-99 m diethylenetriamine pentaacetic acid

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The authors would like to acknowledge the multidisciplinary team at GEM Hospital, Coimbatore, including the departments of Gynecology, Urology, Radiology, and Anesthesiology, for their collaborative support in the diagnosis, surgical management, and follow-up of patients included in this study. We also thank the medical records department for assistance with data retrieval. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that have no conflict of interest. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from the patients included in the study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Duraiswamy, K.Y., Meghana, K., Dharshini, S. et al. The Silent Kidney—Unmasking the Urinary Tract Involvement in Endometriosis—An Observational Study at a Tertiary Care Hospital. J Obstet Gynecol India (2026). https://doi.org/10.1007/s13224-026-02389-5 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s13224-026-02389-5