Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis

Liliana Mereu, Gagliardi ML, Maria Lucia Gagliardi, Clarizia R, Roberto Clarizia, Mainardi P, Paride Mainardi, Stefano Landi, Landi S, Minelli L, Luca Minelli
Fertility and sterility · 2008 · vol. 93(1) , pp. 46–51 · doi:10.1016/j.fertnstert.2008.09.076 · PMID:18990377 · W2075745612
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This paper describes the laparoscopic management of ureteral endometriosis, focusing on cases with moderate to severe hydroureteronephrosis.

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Abstract

OBJECTIVE: To evaluate prospectively the efficacy of laparoscopic ureterolysis versus ureteroureterostomy in women with ureteral endometriosis. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, Ospedale Sacro Cuore of Negrar, Verona, Italy, a tertiary care endometriosis referral center. PATIENT(S): Endometriotic patients with moderate-severe ureter dilatation. INTERVENTION(S): All women underwent laparoscopic endometriosis excision and concomitant laparoscopic ureterolysis, ureteroureterostomy, nephrectomy, or laparotomic ureterocystoneostomy. MAIN OUTCOME MEASURE(S): Clinical outcomes were evaluated. RESULT(S): Fifty-six patients with preoperative or intraoperative evidence of moderate-severe ureter dilatation were enrolled. Dysmenorrhea (91%) and dyspareunia (68%) were the symptoms more frequently reported; only two patients had typical obstructive uropathy pain. In 35 cases, laparoscopic ureterolysis, in 17 laparoscopic ureteroureterostomy, in 2 laparotomic ureterocystoneostomy, and in 2 laparoscopic nephrectomy was performed. 11 out of 35 (31.4%) major complications occurred in the ureterolysis group, and 2 out of 17 (11.7%) in the ureteroureterostomy group. Median follow-up time was 21 months. Ureteral endometriosis recurrence was surgically detected in three patients who underwent conservative ureteral surgery. CONCLUSION(S): Preoperative planning should be rigorous, and complete surgical excision of ureteral endometriosis should be ensured by a team of experts familiar with endometriosis, its multiple manifestations, and its management.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Hydronephrosis Laparoscopy Laparoscopy Laparoscopy Nephrectomy Nephrectomy Nephrectomy Ureter Ureteral Diseases Ureterostomy Ureterostomy Ureterostomy Adult Adult Dilatation, Pathologic Dilatation, Pathologic Endometriosis Endometriosis Endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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