Ureteral Obstruction in Endometriosis

Amit Mani Upadhyay, Ashok Kumar Kunwar, Sanjesh Bhakta Shrestha, Kabir Tiwari, Hema Kumari Pradhan, Ganesh Dangal
In: Nepal Journal of Obstetrics and Gynaecology · 2018 · vol. 13(2) , pp. 35–40 · doi:10.3126/njog.v13i2.21712 · W2918552294
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This retrospective review of six ureteral endometriosis cases found that surgical intervention, including ureterolysis, ureterectomy with anastomosis, or ureteroneocystostomy, is the primary treatment, often necessitated by extrinsic ureteral involvement.

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This retrospective case series studied six patients diagnosed with ureteral endometriosis referred to a surgical department between September 2015 and August 2018, describing the patterns of ureteral involvement and management approaches. The key findings were that all patients had ureter involvement, with cases treated by diagnostic ureteroscopy and retrograde double J stenting when distal stenosis was mild, whereas others showed worsening hydroureteronephrosis after stenting and subsequently underwent ureteroneocystostomy. In the remaining cases, ureteroscopy-guided stenting failed due to stenosed ureter, leading to open abdominal hysterectomy with excision of endometriotic cyst, ureterolysis, and double J stenting. The paper notes diagnostic difficulty due to rare disease presentation with nonspecific symptoms, and its main limitation is the small number of cases. This paper is centrally about endometriosis — it specifically describes ureteral endometriosis causing ureteral obstruction and the associated surgical treatment pathways.

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Abstract

Aim: Endometriosis is defined as functional endometrial glands and stroma that occur outside the uterine cavity. It is an estrogen dependent, benign, inflammatory disease that affects women during premenarcheal, reproductive and postmenopausal hormonal stages. Methods: This is a retrospective review of six cases with diagnosis of ureteral endometriosis. All the patients were referred to Department of Surgery, Kathmandu Model Hospital and the study period was from September 2015 to August 2018. Results: In our study all the patients had involvement of the ureter. All the patients who had undergone open surgery had extrinsic involvement of the ureter. Two patients who had mild distal ureteric stenosis only were managed by diagnostic URS and retrograde DJ stenting. Another two patients with right distal ureteric stenosis were managed initially with retrograde DJ stenting but after removal of ureteric stent and in subsequent follow up the degree of hydroureteronephrosis increased in both the cases. These two patients were finally undergone right Lich Gregoir ureteroneocystostomy. In the remaining two patients, ureterorenoscopy (URS) guided double J stenting were attempted but failed to insert the stent due to stenosed ureter so they underwent open abdominal hysterectomy with excision endometriotic cyst with ureterolysis and double J stenting. Conclusions: Ureteral endometriosis is a rare disease presenting most commonly with nonspecific symptoms and signs and thus making preoperative diagnosis often difficult for the clinicians. Treatment of ureteral endometriosis is primarily surgical. The surgical procedures which are usually performed are excision of all endometriosis lesion, ureterolysis, ureterectomy with ureteroureteral anastomosis and ureteroneocystomy.
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Keywords

Diagnostic ureteroscopy, endometriosis, ureterolysis, ureteroneocystostomyAbstract Aim: Endometriosis is defined as functional endometrial glands and stroma that occur outside the uterine cavity. It is an estrogen dependent, benign, inflammatory disease that affects women during premenarcheal, reproductive and postmenopausal hormonal stages.

Methods

This is a retrospective review of six cases with diagnosis of ureteral endometriosis. All the patients were referred to Department of Surgery, Kathmandu Model Hospital and the study period was from September 2015 to August 2018.

Results

In our study all the patients had involvement of the ureter. All the patients who had undergone open surgery had extrinsic involvement of the ureter. Two patients who had mild distal ureteric stenosis only were managed by diagnostic URS and retrograde DJ stenting. Another two patients with right distal ureteric stenosis were managed initially with retrograde DJ stenting but after removal of ureteric stent and in subsequent follow up the degree of hydroureteronephrosis increased in both the cases. These two patients were finally undergone right Lich Gregoir ureteroneocystostomy. In the remaining two patients, ureterorenoscopy (URS) guided double J stenting were attempted but failed to insert the stent due to stenosed ureter so they underwent open abdominal hysterectomy with excision endometriotic cyst with ureterolysis and double J stenting.

Conclusions

Ureteral endometriosis is a rare disease presenting most commonly with nonspecific symptoms and signs and thus making preoperative diagnosis often difficult for the clinicians. Treatment of ureteral endometriosis is primarily surgical. The surgical procedures which are usually performed are excision of all endometriosis lesion, ureterolysis, ureterectomy with ureteroureteral anastomosis and ureteroneocystomy. Downloads Downloads Published How to Cite Issue Section License Copyright on any research article in the Nepal Journal of Obstetrics and Gynaecology is retained by the author(s). The authors grant the Nepal Journal of Obstetrics and Gynaecology a license to publish the article and identify itself as the original publisher. Articles in the Nepal Journal of Obstetrics and Gynaecology are Open Access articles published under the Creative Commons CC BY-NC License (https://creativecommons.org/licenses/by-nc/4.0/) This license permits use, distribution and reproduction in any medium, provided the original work is properly cited, and it is not used for commercial purposes.

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Condition tags

endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (26)

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