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Fertil Steril. 2010 Jan;93(1):46-51. doi: 10.1016/j.fertnstert.2008.09.076. Epub 2008 Nov 5.

Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis.

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1
Department of Obstetrics and Gynecology, Ospedale Sacro Cuore di Negrar, Verona, Italy. liliana_mereu@yahoo.com

Abstract

OBJECTIVE:

To evaluate prospectively the efficacy of laparoscopic ureterolysis versus ureteroureterostomy in women with ureteral endometriosis.

DESIGN:

Prospective study.

SETTING:

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore of Negrar, Verona, Italy, a tertiary care endometriosis referral center.

PATIENT(S):

Endometriotic patients with moderate-severe ureter dilatation.

INTERVENTION(S):

All women underwent laparoscopic endometriosis excision and concomitant laparoscopic ureterolysis, ureteroureterostomy, nephrectomy, or laparotomic ureterocystoneostomy.

MAIN OUTCOME MEASURE(S):

Clinical outcomes were evaluated.

RESULT(S):

Fifty-six patients with preoperative or intraoperative evidence of moderate-severe ureter dilatation were enrolled. Dysmenorrhea (91%) and dyspareunia (68%) were the symptoms more frequently reported; only two patients had typical obstructive uropathy pain. In 35 cases, laparoscopic ureterolysis, in 17 laparoscopic ureteroureterostomy, in 2 laparotomic ureterocystoneostomy, and in 2 laparoscopic nephrectomy was performed. 11 out of 35 (31.4%) major complications occurred in the ureterolysis group, and 2 out of 17 (11.7%) in the ureteroureterostomy group. Median follow-up time was 21 months. Ureteral endometriosis recurrence was surgically detected in three patients who underwent conservative ureteral surgery.

CONCLUSION(S):

Preoperative planning should be rigorous, and complete surgical excision of ureteral endometriosis should be ensured by a team of experts familiar with endometriosis, its multiple manifestations, and its management.

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