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Ureteral endometriosis: a complication of rectovaginal endometriotic (adenomyotic) nodules
Jacques Donnez1, Michelle Nisolle, Jean Squifflet
1Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Service de Gynécologie, Brussels, Belgium. donnez@gyne.ucl.ac.be
Objective:
To present data from 18 cases of ureteral endometriosis.
Design:
Prospective clinical study.
Setting:
Department of gynecology at a university hospital.
Patient(S):
Four hundred and five patients with severe dysmenorrhea or deep dyspareunia due to a rectovaginal endometriotic (adenomyotic) nodule.
Intervention(S):
Patients were prospectively evaluated using intravenous pyelography. All patients underwent laparoscopic surgery to remove rectovaginal adenomyosis and ureterolysis.
Main Outcome Measure(S):
Presurgical and postsurgical evaluation and histologic analysis.
Result(S):
Preoperative intravenous pyelography revealed ureteral stenosis with ureterohydronephrosis in 18 patients (4.4%). A significantly higher prevalence (11.2%) was observed in nodules > or = 3 cm in diameter. Five women (20%) had complete ureteral stenosis. Kidney scintigraphy revealed damaged kidney parenchymal function, which ranged from 18% to 42%. Laparoscopic ureterolysis was done in 16 women; 2 women underwent ureteral resection and uretero-ureterostomy. A significant postoperative decrease in ureterohydronephrosis was noted in all patients; however, renal function improved only slightly.
Conclusion(S):
Ureteral endometriosis was found in 4.4% of patients with rectovaginal endometriotic (adenomyotic) nodules. Ureterolysis and removal of associated adenomyotic lesions was sufficient therapy in most patients; two required resection of the ureteral stenotic segment. Intravenous pyelography should be performed in all women with rectovaginal nodules > or = 3 cm to prevent nonreversible loss of renal function.
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