Obstructive uropathy associated with primary ureteral endometrioma: case report and review of the literature

Obstructive uropathy associated with primary ureteral endometrioma: case report and review of the literature DOI: https://doi.org/10.5489/cuaj.1098Abstract We report the case of a 56-year-old postmenopausal woman who presented with incidental left hydronephrosis during an investigation for a gastrointestinal complaint. The patient denied any history of flank pain or hematuria. Contrast-enhanced computed tomography revealed severe right-sided ureterohydronephrosis as well as renal atrophy. The contralateral kidney was normal, as was the patient’s overall renal function. A retrograde ureterogram demonstrated complete ureteral obstruction 4 cm proximal to the ureterovesical junction. Subsequent ureteroscopy revealed a polypoid mass completely occupying the ureteral lumen, of which the biopsies demonstrated inconclusive atypical urothelial changes. The patient underwent a laparoscopic nephrectomy with open dissection of the distal ureter. The patient recovered well postoperatively. Final pathology revealed a benign obstructing endometrioma without evidence of invasion from periureteral tissue. This appears to be the first reported case of asymptomatic primary ureteral endometrioma with secondary renal atrophy. Earlier investigation and treatment may have allowed for renal preservation earlier in the course of the disease. Nous décrivons le cas d’une femme ménopausée de 56 ans présentant une hydronéphrose gauche découverte de façon fortuite au cours d’un examen mené pour donner suite à des symptômes gastro- intestinaux. La patiente n’avait pas d’antécédents de douleur au flanc ou d’hématurie. Une TDM avec agent de contraste a révélé une urétéro-hydronéphrose droite importante accompagnée d’une atrophie rénale. Le rein controlatéral et la fonction rénale globale de la patiente ne présentaient aucune anomalie. Une urétérographie par voie rétrograde a permis d’observer une obstruction complète de l’uretère proximale à 4 cm de la jonction urétérovésicale. Une urétéroscopie subséquente a révélé une masse polypoïde occupant la totalité de la lumière urétérale et des analyses après biopsie ont montré des changements atypiques non concluants au niveau de l’épithélium urinaire. La patiente a subi une néphrectomie par laparoscopie avec dissection ouverte de l’uretère distale. La patiente s’est bien rétablie après l’intervention. Le rapport final de pathologie a révélé un endométriome obstructif bénin sans signe d’invasion des tissus péri-urétéraux. Il semble que ce soit ici le premier cas signalé d’endométriome urétéral primitif asymptomatique avec atrophie rénale secondaire. Un examen et un traitement réalisés plus tôt dans le cours de l’évolution de la maladie auraient pu permettre la préservation du rein. Downloads Downloads How to Cite Issue Section License You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA: - Post the Article on any Web site - Translate or authorize a translation of the Article - Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so - Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so. The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request. You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article. The CUA also requires you to warrant the following: - That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party; - That all individuals who have made a substantive contribution to the article are acknowledged; - That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and - That the Article does not libel or violate the privacy rights of any third party.