Ureteral endometriosis with impairment of unilateral renal function at the time of initial examination: A report of three cases

Yoshifumi Ochi, Shiori Yanai, Yasunori Yoshino, Kiyoshi Kanno, Tomonori Hada, Yasuo Yamamoto, Tadayoshi Kunitomo, M. Andou
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(2) , pp. 118–124 · doi:10.5180/jsgoe.38.2_118 · W4317924094
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This report describes three cases of ureteral endometriosis presenting with unilateral renal function impairment at initial examination, highlighting the potential for delayed diagnosis and treatment.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This case report describes three women in whom ureteral endometriosis caused impaired unilateral renal function at initial presentation, including one with prior hydronephrosis found at a checkup without symptoms, and others with delayed recognition despite gynecologic histories of rectal endometriosis or adenomyosis. Across cases, high-level evaluation with imaging (CT/MRI) identified ureteral involvement and renal impairment, and treatment included combinations of hysterectomy, adnexal resection, and in two cases ureter- and kidney–related surgery such as left nephroureterectomy or ureteral procedures. The key finding emphasized is that even advanced ureteral endometriosis may present with few subjective symptoms, and asymptomatic hydronephrosis can reflect ureteral disease. Limitations include the small, descriptive nature of three cases without comparative outcomes. This paper is centrally about endometriosis — it reports ureteral endometriosis cases with loss of unilateral renal function and discusses related diagnostic considerations including in patients with suspected or known adenomyosis.

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Abstract

Introduction: The prognosis of ureteral endometriosis is good if proper treatment is applied, but lack of subjective symptoms often lead to poor treatment. The disease comprises as low as 0.1％ of all pelvic endometriosis and 10％ of urinary tract endometriosis. Therefore, both patients and doctors are usually unaware of the seriousness of the disease, and in some cases, patients do not seek medical attention although problems are noted during examinations. Even when medical attention is sought, treatment is delayed because of the lack of a proper diagnosis. In this report, we describe three cases in which unilateral renal function was impaired due to ureteral endometriosis.
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Introduction

The prognosis of ureteral endometriosis is good if proper treatment is applied, but lack of subjective symptoms often lead to poor treatment. The disease comprises as low as 0.1％ of all pelvic endometriosis and 10％ of urinary tract endometriosis. Therefore, both patients and doctors are usually unaware of the seriousness of the disease, and in some cases, patients do not seek medical attention although problems are noted during examinations. Even when medical attention is sought, treatment is delayed because of the lack of a proper diagnosis. In this report, we describe three cases in which unilateral renal function was impaired due to ureteral endometriosis. Case 1: A 51-year-old woman was diagnosed with hydronephrosis at a checkup two years ago, but she had no symptoms and did not seek medical care. She visited her previous doctor for dysmenorrhea, irregular bleeding, and hematuria, and was referred to our hospital after CT and MRI scans revealed uterine fibroids, rectal endometriosis, and a left ureteral tumor. In addition to laparoscopic hysterectomy, bilateral adnexal resection, and low anterior resection, laparoscopic total left nephroureterectomy was performed. Case 2: A 52-year-old woman was diagnosed with adenomyosis at another hospital more than 10 years ago, but the condition was difficult to treat because of poorly controlled hypertension. Graves'disease was diagnosed three months before her first visit, and preoperative examination showed abnormal renal function. CT showed left hydronephrosis, right nonfunctioning kidney, and uterine adenomyosis. She underwent the robot-assisted total hysterectomy, bilateral adnexal resection, and left vesicoureteral neoanastomosis. Case 3: A 48-year-old woman visited her previous doctor because of abdominal pain and vomiting. MRI revealed multiple uterine fibroids and a left nonfunctioning kidney. Robot-assisted total hysterectomy, bilateral salpingo-oophorectomy, and left ureterolysis were performed.

Conclusion

Even in advanced cases of ureteral endometriosis, about half of the patients have few symptoms. Asymptomatic hydronephrosis should lead to a suspicion of ureteral endometriosis. It is also important to consider ureteral endometriosis even if adnexal lesions are not suspected. © 2022 日本産科婦人科内視鏡学会

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Condition tags

endometriosis

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