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  • Title: Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis.
    Author: Mereu L, Gagliardi ML, Clarizia R, Mainardi P, Landi S, Minelli L.
    Journal: Fertil Steril; 2010 Jan; 93(1):46-51. PubMed ID: 18990377.
    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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