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[Ureteral endometriosis: urological features].
Ezio Frego1, Alessandro Antonelli, Luigi Tralce
1Divisione Clinicizzata di Urologia, Università degli Studi di Brescia.
Summary
Severe ureteral endometriosis, though rare, requires prompt diagnosis and treatment. Ureteric resection with ureteroneocystostomy offers the best long-term cure rates for this challenging condition.
Area of Science:
- Urology
- Gynecology
- Surgical Oncology
Background:
- Endometriosis affects 10-20% of premenopausal women; ureteral involvement is rare (0.1-0.4%).
- Clinical and radiological features of ureteral endometriosis are non-specific, complicating preoperative diagnosis.
- Intravenous urography is essential for diagnosing pelvic endometriosis with potential ureteral compromise.
Purpose of the Study:
- To evaluate treatment outcomes for severe ureteral endometriosis.
- To identify the most effective surgical approach for ureteral endometriosis.
Main Methods:
- Retrospective review of 10 patients with severe ureteral endometriosis (1995-2001).
- Surgical interventions included bilateral stenting with hormonal therapy, ureteral resection with primary reanastomosis, and ureteric resection with ureteroneocystostomy.
- Follow-up included assessment for recurrence and long-term outcomes.
Main Results:
- One patient with bilateral ureteral endometriosis treated with stenting and hormonal therapy had good results.
- Two patients underwent ureteral resection with primary reanastomosis; one experienced relapse requiring secondary surgery.
- Seven patients treated with ureteric resection and ureteroneocystostomy showed no recurrences (median follow-up 31 months).
Conclusions:
- Ureteric resection combined with ureteroneocystostomy provides the best chance for curing severe ureteral endometriosis.
- Adjuvant hormonal therapy or hysteroadnexiectomy is crucial for minimizing relapse risk.
- Early diagnosis and appropriate surgical management are vital for favorable patient outcomes.