Outcome of laparoscopic ureterolysis for ureteral endometriosis
Fabio Ghezzi1, Antonella Cromi, Valentino Bergamini
1Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. fabio.ghezzi@uninsubria.it
Objective:
To evaluate the adequacy of laparoscopic ureterolysis as a primary treatment option for ureteral endometriosis.
Design:
Prospective collaborative cohort study.
Setting:
Gynecologic departments of three university hospitals.
Patient(S):
Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography.
Intervention(S):
Laparoscopic ureterolysis.
Main Outcome Measure(S):
Cure rate, disesase recurrence.
Result(S):
Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral ligaments endometriosis in 65.5% (22/34) of cases. No inadvertent ureteral injuries occurred during ureterolysis. A partial wall resection of the ureter was necessary in one case and a segmental ureteral resection with vescicopsoas hitch was required in a women with intrinsic ureteral endometriosis. The median (range) follow-up time was 16 months (range: 3-53 months). Thirty-two patients (96.7%) had a patent ureter on the 3-month postoperative intravenous pyelography. The recurrence rate of ureteral lesions was 12.1% (4/33).
Conclusion(S):
Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:28Urologic Endoscopic Procedure: Cystoscopic Examination