Bilateral endometriosis of the ureter

R. M. Kuntz
In: International Urogynecology Journal · 1993 · vol. 4(2) , pp. 121–125 · doi:10.1007/bf00376427 · W2005840586
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Bilateral ureteral endometriosis causing obstruction was diagnosed via ureteroscopy failure and partial ureterectomy, highlighting the need for gynecologists and urologists to consider this rare condition in premenopausal women.

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This paper reports a rare case of bilateral ureteral endometriosis causing bilateral ureteral obstruction, in which ureteroscopy failed to identify endometriosis and diagnosis was only achieved after bilateral partial ureterectomy with end-to-end anastomosis. It describes two proposed mechanisms of obstruction—extrinsic periureteral compression or intrinsic involvement of the ureteral wall—and notes that kidney destruction may occur with few or no gynecologic or urologic symptoms. The authors’ main caveat is that clinical detection can be delayed because standard endoscopic evaluation may not reveal the lesion. This paper is centrally about endometriosis — it specifically documents bilateral ureteral endometriosis presenting with bilateral ureteral obstruction and highlights diagnostic limitations.

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Abstract

A case of bilateral endometriosis of the ureter with bilateral ureteral obstruction is reported. Ureteroscopy failed to detect endometriosis, and only bilateral partial ureterecomy with end-to-end anastomosis revealed the diagnosis. Bilateral endometriosis is very rare. Either extrincic periureteral compression or intrinsic involvement of the ureteral wall causes ureteral obstruction, and may destroy the kidneys with few or no gynecological or urological symptoms. To facilitate early diagnosis and the initiation of appropriate therapy, the gynecologist should regularly search for clinical signs and symptoms of upper urinary tract obstruction in all women with genital endometriosis or a history of previous surgery for genital endometriosis. When renal ultrasound shows upper urinary tract dilatation, ureteral endometriosis should be suspected. The urologist should think of ureteral endometriosis in a premenopausal woman with unilateral or bilateral distal ureteral obstruction of unknown cause, especially when she suffers from genital endometriosis or has a history of this disease. Similar content being viewed by others

References

Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986;67:335–338 Slutsky JN, Callahan D. Endometriosis of the ureter can present as renal failure: a case report and review of endometriosis affecting the ureters. J Urol 1983;130:336–337 Abeshouse BS, Abeshouse G. Endometrosis of the urinary tract: a review of the literature and a report of four cases of vesical endometriosis. J Int Coll Surg 1966;34:43–63 Kerr WS. Endometrosis involving the urinary tract. Clin Obstet Gynecol 1966; 9:331–357 Klein RS, Cattolica EV. Ureteral endometriosis. Urology 1979;3:477–482 Cullen TS. Adenomyoma of the rectovaginal septum. Bull Johns Hopkins Hosp 1917;28:343–349 Simon HB, Zimet RR, Schneider E, Morgenstern, LL. Bilateral ureteral obstruction due to endometriosis. JAMA 1963;183:487–489 Yates-Bell AJ, Molland EA, Pryor, JP. Endometriosis of the ureter. Br J Urol 1972;44:58–67 Reddy A, Evans AT. Endometrosis of the ureters. Urology 1974;3:474–477 Moore JG, Hibbard LT, Growdon WA, Schifrin BS. Urinary tract endometriosis: Enigmas in diagnosis and management. Am J Obstet Gynecol 1979;134:162–172 Gourdie RW, Rogers ACN. Bilateral ureteric obstruction due to endometriosis presenting with hypertension and cyclical oliguria. Br J Urol 1986;58:224. Ball TL, Platt MA. Urologic complications of endometriosis. Am J Obstet Gynecol 1962;84:1516–1521 Gardner B, Whitaker RH. The use of danzol for ureteral obstruction caused by endometriosis. J Urol 1981;125:117–118 Ray J, Longer M, Ireland K. Ureteral obstruction in postmenopausal women with endometriosis. Urology 1983;26:577–578 Author information Authors and Affiliations Rights and permissions About this article Cite this article Kuntz, R.M. Bilateral endometriosis of the ureter. Int Urogynecol J 4, 121–125 (1993). https://doi.org/10.1007/BF00376427 Issue date: DOI: https://doi.org/10.1007/BF00376427

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endometriosis

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