Ureteral endometriosis diagnosed at ureteroscopy

BACKGROUND: Intrinsic ureteral endometriosis is rare. Early detection and treatment is extremely important to preserve renal function. CASE: A 37-year-old woman with right flank pain was diagnosed with a polypoid lesion at excretory urogram. The polyp was removed under ureteroscopy and was found to be endometriosis. Subsequent exploratory laparotomy and ureterolysis failed to document other foci of endometriosis. Resection of the ureter was not needed. She received medroxyprogesterone for 6 months, and a ureteral stent was left in place for 3 months postoperatively. Excretory urogram showed no obstruction 6 months postoperatively. CONCLUSION: This appears to be the first reported case of ureteral endometriosis documented initially at ureteroscopy. Prompt treatment may relieve symptoms and preserve renal function. Resection of the ureter may be avoided in some patients.