Bilateral extrinsic endometriosis of the ureters with renal failure: A case report

Diaa E. E. Rizk
In: International Urogynecology Journal · 1994 · vol. 5(1) , pp. 52–55 · doi:10.1007/bf00451718 · W1968500563
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This case report describes a patient with chronic renal failure caused by bilateral extrinsic ureteral endometriosis, which was successfully treated with ureterolysis, salpingo-oophorectomy, and hysterectomy.

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This paper reports a case of chronic renal failure attributed to bilateral extrinsic ureteral endometriosis in a patient presenting with acute abdominal pain before a planned radical surgical procedure. High-level evaluation included physical examination revealing bilateral adnexal masses and pelvic nerve compression with sensory loss, and incidental investigations showing deranged renal function and obstructive uropathy; the report notes the patient did not have menstrual dysfunction or urinary symptoms. The authors describe ureterolysis with bilateral salpingooophorectomy and subtotal hysterectomy, with successful relief of the obstruction, and emphasize that ureteral endometriosis can be overlooked because it is usually asymptomatic and rare, while potentially causing irreversible renal damage. This paper is centrally about endometriosis — it specifically documents bilateral extrinsic ureteral endometriosis causing renal failure and discusses the need for surgical vigilance.

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Abstract

Ureteral involvement in endometriosis is usually overlooked because it complicates less than 0.5% of cases and remains asymptomatic in the majority. Despite its rarity, ureteral endometriosis is important because the consequent irreversible renal damage may cause considerable morbidity. A case of chronic renal failure caused by bilateral extrinsic endometriosis is described. The patient presented with acute abdominal pain prior to the planned radical surgical procedure. She did not complain of menstrual dysfunction or urinary symptoms. Bilateral adnexal masses and the sensory loss of pelvic nerve compression were found on physical examination. Incidental routine investigations showed deranged renal function and obstructive uropathy. Ureterolysis, bilateral salpingooophorectomy and subtotal hysterectomy successfully relieved the obstruction. The potential existence of ureteral endometriosis should be realized. Vigilance in performing surgery offers the best chance of cure. Similar content being viewed by others

References

Denes FT, Pompeo ACL, Montellato NID, Lopes RN. Ureteral endometriosis. Int Urol Nephrol 1980;12:205–209 Case Records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 49-1987. A 48-year-old woman with a history of nephrolithiasis, ureteral narrowing, and an adnexal mass. N Engl J Med 1987;371:1456–1464 Moore JG, Hibart LT, Growden WA, Shifrin BS. Urinary tract endometriosis: engimas in diagnosis and management. Am J Obstet Gynecol 1979;134:162–172 Kerr WS. Endometriosis involving the urinary tract. Clin Obstet Gynecol 1966;9:331–357 Gehr TW, Sica DA. Case report and review of the literature: ureteral endometriosis. Am J Med Sci 1987;294:346–352 Klein RS, Cattolica E. Ureteral endometriosis. Urology 1979;13:477–482 Reddy AN, Evans AT. Endometriosis of the ureters. J Urol 1974;111:474–480 Stiehm WD, Becker JA, Weiss RM. Ureteral endometriosis. Radiology, 1972;102:563–565 Langmade CF. Pelvic endometriosis and ureteral obstruction. Am J Obstet Gynecol 1975;122:463–469 Keily EA, Grainger R, Kay EW, Butler MR. Post-menopausal ureteric endometriosis. Br J Urol 1988;62:91–92 Rivlin ME, Miller JD, Krueger RP, Patel RB, Bower JD. Leuprolide acetate in the management of ureteral obstruction caused by endometriosis. Obstet Gynecol 1990;75:532–536 Matsuura K, Kawasaki N, Oka M, Hisao II, Maeyama M. Treatment with danazol of ureteral obstruction caused by endometriosis. Acta Obstet Gynecol Scand 1985;64:339–343 Waxman J, Man A, Hendry WF, Whitfield HN, Besser GM. Importance of early tumour exacerbation in patients treated with long-acting analogues of gonadotrophin releasing hormone for advanced prostatic cancer. Br Med J 1985;291:1387–1388 Neves-e-Castro M, Correia MFC. Use of luteinizing hormone-releasing hormone analogs in non-neoplastic gynecologic conditions. Semin Reprod Endocrinol 1987;5:411–419 Reid BA, Gangar KF, Beard RW. Severe endometriosis treated with gonadotrophin releasing hormone agonist and continuous combined hormone replacement therapy. Br J Obstet Gynaecol 1992;99:344–345 Author information Authors and Affiliations Rights and permissions About this article Cite this article Rizk, D.E.E. Bilateral extrinsic endometriosis of the ureters with renal failure: A case report. Int Urogynecol J 5, 52–55 (1994). https://doi.org/10.1007/BF00451718 Issue date: DOI: https://doi.org/10.1007/BF00451718

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endometriosis

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