Multidisciplinary Team Approach to Management of Severe Endometriosis Affecting the Ureter: Long-term Outcome Data and Treatment Algorithm

David Soriano, Ron Schonman, Andrei Nadu, Oshrit Lebovitz, Eyal Schiff, Daniel S. Seidman, Mordechai Goldenberg

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective: To examine the efficiency of laparoscopic ureterolysis for ureteral endometriosis and to describe appropriate treatment. Design: Prospective trial (Canadian Task Force classification II-2). Setting: University hospital. Patients: Forty-five patients who underwent surgery to treat ureteral endometriosis between 2005 and 2009. Intervention: Laparoscopic ureteral ureterolysis. Measurements and Main Results: Long-term follow up of symptoms, urinary tract anatomy and function, and the need for further intervention were performed. Ureteral endometriosis was observed in 14.2% of 315 patients with endometriosis. Of the 45 study patients, 95.5% had dysmenorrhea, 60% had dyspareunia, and 45% were infertile. Half of the patients had previously undergone laparoscopic procedures. Urinary tract symptoms were present in 15.9% of patients. Preoperative hydronephrosis or hydroureter was observed in 10 patients (22.2%), and impaired urinary function in 2 patients (4.4%). Laparoscopy demonstrated left ureteral involvement in 82.2% of patients, and deep infiltrative endometriosis in 80%. Laparoscopic ureterolysis was feasible in 91.1% of patients. In 4 patients, ureterolysis was not feasible, and primary reimplantation of the ureter was performed. Forty-one patients (91.1%) had no symptoms or had marked improvement postoperatively and required no further treatment. Two patients (4.8%) underwent repeat surgery. In 80% of patients with hydroureteronephrosis, the postoperative sonogram was normal. Conclusions: Ureteral endometriosis can be treated effectively using laparoscopic ureterolysis in almost all patients. Different treatment approaches should be based on the results of preoperative evaluation and operative findings by a multidisciplinary team. Urinary assessment is crucial because most patients demonstrate no urinary tract symptoms and initial renal investigation can prevent irreversible damage.

Original languageEnglish
Pages (from-to)483-488
Number of pages6
JournalJournal of Minimally Invasive Gynecology
Volume18
Issue number4
DOIs
StatePublished - Jul 2011

Keywords

  • Deep infiltrative endometriosis
  • Laparoscopic ureterolysis
  • Ureteral endometriosis

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