Deep-infiltrating endometriosis with primary presentation as obstructive uropathy: report of two cases

Richa Vatsa, Neena Malhotra, Smita Manchanda, Juhi Bharti
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(6) , pp. 2217–2220 · doi:10.18203/2320-1770.ijrcog20261633 · W7162652432
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Two cases of deep-infiltrating endometriosis presented unusually with obstructive uropathy mimicking urological pathology, leading to significant renal damage in one patient and requiring intervention in both.

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This paper reports two cases of deep-infiltrating endometriosis presenting with obstructive uropathy and flank pain that mimicked urological pathology, despite lacking typical gynecologic features such as dysmenorrhea, chronic pelvic pain, or infertility. In one case, long-standing hydroureteronephrosis led to a unilateral nonfunctional kidney, managed with nephrectomy, while the other case’s obstructive uropathy was treated with bilateral percutaneous nephrostomy; fertility-preserving endometriosis surgery was performed in both. The authors emphasize that by the time urinary symptoms arise, renal damage may be irreversible, and they frame the main limitation as the inherent constraint of reporting only two cases. This paper is centrally about endometriosis — specifically deep-infiltrating endometriosis causing ureteral obstruction and obstructive uropathy as the initial presentation.

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Abstract

Endometriosis can have a broad spectrum of presentation and may sometimes affect/encase ureters leading to scarring, adhesion formation and obstruction resulting in backpressure changes in kidneys and ureters. Ureteral endometriosis is generally asymptomatic for long term. By the time symptoms arise, renal damage can be irreversible. Two of our cases had an unusual presentation of flank pain, mimicking urological pathology. Both had obstructive uropathy without any of the typical gynecological features of endometriosis like dysmenorrhea, chronic pelvic pain or infertility. One had a unilateral nonfunctional kidney due to long standing hydroureteronephrosis, for which a nephrectomy was done. In other, obstructive uropathy was managed with bilateral percutaneous nephrostomy. Fertility-preserving surgery for endometriosis was done in both the cases. To conclude, endometriosis can have non-gynecological presentation also. So, in reproductive age females presenting with obstructive uropathy, endometriosis should always be kept as differential diagnosis. Endometriosis can be a silent killer for kidneys.
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Deep-infiltrating endometriosis with primary presentation as obstructive uropathy: report of two cases DOI: https://doi.org/10.18203/2320-1770.ijrcog20261633Keywords: Deep infiltrating endometriosis\, Nephrectomy, Obstructive uropathyAbstract Endometriosis can have a broad spectrum of presentation and may sometimes affect/encase ureters leading to scarring, adhesion formation and obstruction resulting in backpressure changes in kidneys and ureters. Ureteral endometriosis is generally asymptomatic for long term. By the time symptoms arise, renal damage can be irreversible. Two of our cases had an unusual presentation of flank pain, mimicking urological pathology. Both had obstructive uropathy without any of the typical gynecological features of endometriosis like dysmenorrhea, chronic pelvic pain or infertility. One had a unilateral nonfunctional kidney due to long standing hydroureteronephrosis, for which a nephrectomy was done. In other, obstructive uropathy was managed with bilateral percutaneous nephrostomy. Fertility-preserving surgery for endometriosis was done in both the cases. To conclude, endometriosis can have non-gynecological presentation also. So, in reproductive age females presenting with obstructive uropathy, endometriosis should always be kept as differential diagnosis. Endometriosis can be a silent killer for kidneys. Metrics References Kołodziej A, Krajewski W, Dołowy Ł, Hirnle L. Urinary tract endometriosis. Urol J. 2015;12(4):2213-7. Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int. 2013;91:1-9. DOI: https://doi.org/10.1159/000345140 Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, et al. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int. 2012;89:249-58. DOI: https://doi.org/10.1159/000339519 Ota K, Sato K, Tanaka M. Ureteral stenosis due to deep infiltrating endometriosis with difficulty in treatment: case report and brief literature review. Gynecol Minim Invasive Ther. 2017;6:214-6. DOI: https://doi.org/10.1016/j.gmit.2017.06.007 Nezhat C, Paka C, Gomaa M, Schipper E. Silent loss of kidney secondary to ureteral endometriosis. JSLS. 2012;16:451-5. DOI: https://doi.org/10.4293/108680812X13462882736213 Alaoui Mhammedi W, Ouraghi A, Irzi M, El Moudane A, Mokhtari M, Barki A. Ureteral endometriosis presenting as left ureteral obstruction: a case report. Cureus. 2022;14(9):e29288. DOI: https://doi.org/10.7759/cureus.29288 Tanaka K, Amoako AA, Gray K, Baartz D. Unilateral ureteric endometriosis at the pelvic brim resulting in complete loss of renal function. Case Rep Obstet Gynecol. 2019:9194615. DOI: https://doi.org/10.1155/2019/9194615 Mason RJ, Alamri A, Gusenbauer K, Kapoor A. Intrinsic ureteral endometriosis as a cause of unilateral obstructive uropathy. Can Urol Assoc J. 2016;10(4):119-21. DOI: https://doi.org/10.5489/cuaj.3191 Choi JI, Yoo JG, Kim SJ, Lee HN, Kim MJ. Acute Renal Failure due to Obstructive Uropathy Secondary to Ureteral Endometriosis. Case Rep Obstet Gynecol. 2015;2015:761348. DOI: https://doi.org/10.1155/2015/761348 Talreja D, Salunke V, Pande S, Gupta C. Successful management of ureteric endometriosis by laparoscopic ureterolysis: a review and report of three further cases. Arab J Urol. 2018;16:342-9. DOI: https://doi.org/10.1016/j.aju.2018.03.001 Wang P, Wang XP, Li YY, Jin BY , Xia D, Wang S et al. Hydronephrosis due to ureteral endometriosis in women of reproductive age. Int J Clin Exp Med. 2015;8(1):1059-65. Leonardi M, Espada M, Kho M, Magrina JF, Millischer AE, Savelli L, et al. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment. Diagnostics 2020;10:771. DOI: https://doi.org/10.3390/diagnostics10100771

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endometriosischronic_pelvic_paindysmenorrheainfertility

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