Laparoscopic management of ureteral endometriosis: Our experience

Frenna V, Virginia Frenna, Leonor Maria Pacheco Santos, Leonor Santos, Santos L, Ohana E, Eric Ohana, Bailey C, Charles Bailey, Arnaud Wattiez
Journal of Minimally Invasive Gynecology · 2007 · vol. 14(2) , pp. 169–171 · doi:10.1016/j.jmig.2006.09.009 · PMID:17368251 · W2010015018
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This paper reports on the authors' experience with laparoscopic surgery for managing ureteral endometriosis.

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Abstract

Study objectiveUreteral endometriosis is rare, accounting for less than 0.3% of all endometriotic lesions. The aim of our study is to evaluate the prevalence of extrinsic ureteral endometriosis in women undergoing laparoscopic surgery for severe endometriosis and to suggest that laparoscopic ureterolysis represents a mandatory measure in all cases to avoid ureteral injury.MethodsA retrospective analysis was performed of all cases of patients who underwent laparoscopic surgery for severe endometriosis at the departments of obstetrics and gynecology at CMCO-SIHCUS and Hautepierre Hospital, Strasbourg, from November 2004 through January 2006.Measurements and main resultsWe recorded 54 patients with a mean age of 31 years and a mean body mass index of 21.9. Reported symptoms were dysmenorrhea (88%), severe dyspareunia (88%), severe pelvic pain (38.8%), and infertility (74%). Five women presented with dysuria, frequency, recurrent urinary tract infections, and pain in the renal angle, and 2 patients had hydronephrosis. We observed 3 patients (5.6%) with ureteral stenosis, 35 (64.8%) with adenomyotic tissue surrounding the ureter without stenosis, and 16 (29.6%) with adenomyotic tissue adjacent to the ureter. It was on the left side in 47.4% of cases, on the right side in 31.6% cases, and bilaterally in 21% of cases. In 9 patients, ureteral involvement was associated with bladder endometriosis (16.7%). In all patients, ureterolysis was performed. There was 1 case of ureteral injury during the procedure, 2 of transitory urinary retention, and 1 of uretero-vaginal fistula after surgery. During the first year of follow-up, the disease recurred in 4 patients, with no evidence of the disease in the urinary tract.ConclusionConservative laparoscopic surgery to relieve ureteral obstruction and remove pathologic tissue is the management of choice. Resection of part of the ureter should be performed only in exceptional cases. Ureterolysis should be performed in all patients before endometriotic nodule resection to recognize and prevent any ureteral damage.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Ureter Ureteral Diseases Adult Endometriosis Endometriosis Endometriosis Female Humans Recurrence Retrospective Studies Treatment Outcome Ureter Ureteral Diseases

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