Ureteral endometriosis and loss of renal function: mechanisms and interpretations

Ureteral endometriosis is associated with deep endometriosis and is relatively uncommon. In some patients, progressive obstruction of the lower part of the ureter may occur, with silent loss of renal function as a consequence. We report on three patients with loss of renal function, in whom different pathogenic mechanisms probably were the decisive cause. Failure to diagnose deep endometriosis with ureteral involvement, misinterpretation of hydroureter at magnetic resonance imaging and lack of typical symptoms may all be reasons for development of loss of renal function. With only one functional kidney, these patients should be followed closely with renal function tests and ultrasound, and in certain cases also by magnetic resonance imaging or renal scintigraphy.