Pelvic endometriosis and uretero-hydronephrosis: clinical, imagistic and surgical implications--case report

Endometriosis represent the presence and proliferation of functional endometrial-like tissue outside the uterine cavity, and is a chronic, recurrent, debilitating desease, in which kidney implications are rare, but complex.

Evaluation of clinical, imagistic and surgical implications of uretero-hydronephrosis secondary to recurrent pelvic endometriosis.

30 year old patient diagnosed with primary infertility and left ovarian endometriosis (treated with classically conservative surgical procedure), presented acute onset of obstructive urinary symptoms, requiring internal drainage of the upper urinary straight path (Cook probe) for uretero-hydronephrosis grade III. CT and MRI examination reveals the presence of a imprecise pelvic mass incorporating right distal ureter and uretero-bladder ostium.

In this clinical and laboratory context, classic surgery is practicing with right anexectomy and direct right uretero-vesical reimplantation, also with psoas bladder-hitch. Histopathological examination confirmed the presence of recurrent ovarian endometriosis with right distal ureteral invasion.

Recurent endometriosis, although considered a benign condition, often present invasive characters, determining considerable anatomical destructions and severe symptoms.