Leuprolide acetate in the management of ureteral obstruction caused by endometriosis.
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Leuprolide acetate treatment for 6-9 months relieved ureteral obstruction caused by endometriosis in two of three patients, suggesting a role for GnRH agonist therapy.
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Abstract
Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. The standard therapy is surgical. However, medical treatment has been reported using danazol, progestins, and estrogen-progestin combinations, although solid documentation of the effect of hormonal therapy against ureteral endometriosis is lacking. Gonadotropin-releasing hormone (GnRH) agonist treatment of endometriosis has yielded good results but has not been adequately reported in patients with ureteric involvement. We report three patients treated with a GnRH agonist, leuprolide acetate, for 6-9 months as a preoperative course. One patient had bilateral and two had unilateral obstruction. The preoperative course relieved the obstruction in the patient with bilateral disease and in one with unilateral changes. The failure occurred in a patient with intrinsic ureteric endometriosis. This early experience suggests a place for GnRH agonist therapy for patients with ureteric obstruction due to endometriosis, probably, but not necessarily, in conjunction with a planned surgical procedure. If medical therapy is attempted, close surveillance of renal function is mandatory.
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Cited by (21)
- Ureteroureteral anastomosis for endometriosis involving the ureter: Case series and literature review 2019
- Medical Treatment of Ureteral Obstruction Associated With Ovarian Remnants and/or Endometriosis: Report of Three Cases and Review of the Literature 2014
- Pelvic and Extragenital Endometriosis: A Review of the Surgical Management of Deeply Infiltrating Lesions 2013
- Endometriosis ureteral y vesical 2012
- Endométriose urétérale et vésicale 2012
- Surgical Therapies: Ureteric Dissection and Urological Endometriosis 2011
- Endometriosis infiltrante: revisión de tema Deep endometriosis: a review 2009
- Deep endometriosis: a review 2009
- Prise en charge chirurgicale de l’endométriose de l’appareil urinaire : à propos de 12 cas 2009
- Management of ureteral endometriosis: areas of controversy 2007
- Failure of Laparoscopy to Relieve Ureteral Obstruction Secondary to Endometriosis 2006
- Endometriosis extrapélvica: reporte de tres casos y revisión narrativa de la literatura 2005
- Ureteral Endometriosis with Renal Loss: A Case Report 2004
- Persisting active and proliferative intrinsic ureteral endometriosis under GNRH agonists therapy: a case with immunohistological study 2001
- [Ureteral and vesicular endometriosis: case report]. 1999
- Therapeutic effects of leuprorelin microspheres on endometriosis and uterine leiomyomata 1997
- Ureteral endometriosis revealed by an acute renal failure 1996
- Bilateral extrinsic endometriosis of the ureters with renal failure: A case report 1994
- Leuprorelin 1994
- Laparoscopic Treatment of Obstructed Ureter Due to Endometriosis by Resection and Ureteroureterostomy: A Case Report 1992
- Endometriosis associated with ureteric obstruction. 1991
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