OP12.05: Ureteric endometriosis: detection and assessment of level of obstruction at sonovaginography for deep infiltrating endometriosis (DIE)

Urinary tract endometriosis affects 1% of patients with pelvic endometriosis and, in approximately 10%, there will be ureteric endometriosis. A significant proportion of these patients will have no symptoms or minimal symptoms. Bowel preparation prior to assessment of DIE by sonovaginography greatly aids, not only in the diagnosis of ureteric endometriosis, but also in determining the level of ureteric obstruction. We report 4 cases of ureteric endometriosis detected during sonovaginography. Two of the 4 patients presented with symptoms suggestive of endometriosis, although not reporting urinary tract symptoms. The only presenting symptoms in the third patient were menorrhagia and nonspecific left iliac fossa pain; there was no clinical suspicion of endometriosis. The fourth patient had a unilateral hydronephrosis, which was diagnosed on a CT scan that was ordered to investigate an abnormal renal function test. There was no clinical suspicion of endometriosis in this patient. The level of obstruction varied depending on the level and type of DIE lesion such as paracervical lesion with adherent rectal endometriosis (1), vaginal nodule with adherent large sigmoid nodule (1), left uterosacral ligament nodule with bowel tethering (1) and left lateral pelvic wall deposit with adherent left ovarian endometrioma (1). In all four patients it was the left ureter that was affected. Two patients underwent a nephrectomy. One patient had a stent inserted and is under close surveillance. The patient with periureteric deposits around the left ureter in close proximity to the vaginal vault, with no significant ureteric obstruction, underwent laparoscopic excision of these lesions. Ureteric endometriosis, albeit rare, can cause potentially serious complications due to the effect on renal function. Sonovaginography is helpful in pre operative detection of ureteral endometriosis and management of patient by a multidisciplinary surgical approach. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.