Risk Factors for Irreversible Unilateral Loss of Renal Function in Patients With Deep Endometriosis

Maria Ángeles Martínez‐Zamora, Eduard Mensión, Judith Martínez-Egea, Lluís Peri, A. Franco, Meritxell Gràcia, Cristina Ros, Mariona Rius, Francisco Carmona
In: Research Square · 2023 · doi:10.21203/rs.3.rs-2787009/v1 · W4365149494
preprint OA: green CC0
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study identified infertility, asymptomatic presentation, intestinal deep endometriosis, torus uterinus/uterosacral ligament deep endometriosis, and a negative sliding sign as risk factors for irreversible unilateral loss of renal function in patients with deep endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This retrospective cohort study analyzed 436 patients with histologically confirmed deep endometriosis (DE) who underwent laparoscopic surgery at a tertiary center (2015–2020), comparing 15 patients with irreversible unilateral loss of renal function from unilateral ureteral stenosis (defined by relative renal function <30% on renogram) to 421 patients with preserved renal function. Preoperative epidemiologic, clinical, and radiologic variables (including endometrioma size, intestinal DE, torus uterinus/uterosacral ligament DE, and the sliding sign) were extracted from medical records and assessed with multivariate logistic regression to identify risk factors. The renal-loss group differed by having higher infertility rates and a greater proportion of asymptomatic patients, and multivariate analysis found infertility, being asymptomatic, intestinal DE, torus uterinus/uterosacral ligament DE, and a negative sliding sign to significantly increase risk. A key limitation is that only 15 cases comprised the renal-loss group, which may constrain statistical stability; this paper is centrally about endometriosis — it specifically evaluates risk factors for irreversible unilateral renal function loss in patients with deep endometriosis.

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Abstract

Abstract Background: Deep endometriosis (DE) is usually associated with severe pelvic pain, dysmenorrhea and other pain symptoms and can be more aggressive than other types of endometriosis, even leading to irreversible severe complications such as complete unilateral loss of renal function. Previous data showed that up to 30% of patients with urinary tract DE may have reduced kidney function at the time of diagnosis although the real prevalence is unknown. All doctors and health caregivers involved in endometriosis diagnosis and treatment should be aware of this complication and should suspect and avoid this rare, albeit severe, form of the disease. We aimed to describe the clinical and radiologic characteristics of deep endometriosis (DE) patients diagnosed with irreversible unilateral loss of renal function due to unilateral ureteral stenosis and evaluate risk factors for developing this loss. Methods: Retrospective cohort study including 436 patients who underwent laparoscopic DE surgery. We evaluated two groups of patients according to preserved (Non-Renal Loss Group; n=421) or irreversible unilateral damaged renal function (Renal Loss Group; n=15). Preoperative epidemiologic variables, clinical characteristics, radiologic findings and surgical treatments of all patients were collected. Results: The Renal Loss Group had a higher infertility rate and a higher proportion of asymptomatic patients. The following radiological variables showed statistically significant differences between the two groups: mean endometrioma diameter, the presence of intestinal DE and negative sliding sign. Multivariate analysis showed that infertility, being asymptomatic, having intestinal DE or torus uterinus/uterosacral ligament DE and a negative sliding sign significantly increased the risk of loss of renal function. Conclusions: Some clinical and radiological variables may help identify patients with DE at high risk of presenting loss of renal function due to ureteral stenosis. Therefore, among these patients, severe urinary tract obstruction should be specifically ruled out.

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Condition tags

endometriosisendometriomadysmenorrheainfertility

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