Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

Area of Science:

• Gynecologic surgery
• Urology
• Endometriosis research

Background:

• Deep endometriosis (DE) frequently involves the urinary tract, necessitating ureteral procedures during surgical management.
• Predicting the complexity of ureteral involvement in DE surgery is crucial for surgical planning and patient counseling.

Purpose of the Study:

• To develop a predictive nomogram for the type of ureteral procedure required in pelvic deep endometriosis surgery.
• To identify factors and complications associated with ureteral procedures in deep endometriosis.

Main Methods:

• Retrospective monocentric study of 920 patients undergoing pelvic deep endometriosis surgery.
• Classification of ureteral procedures into simple (isolation) or complex (dissection, resection, nephroureterectomy).
• Multivariate analysis to identify predictors of complex ureteral procedures and associated complications.

Main Results:

• 79% of patients required a ureteral procedure, with 33% classified as complex.
• Predictors for complex procedures included age, prior endometriosis surgery, and ureteral dilatation on MRI.
• Complex procedures were associated with a 3.5% rate of ureteral fistula.

Conclusions:

• A nomogram was developed to predict complex ureteral procedures in deep endometriosis surgery.
• Key predictive factors include age, previous endometriosis surgery, rectovaginal nodule size, rectal/sigmoid involvement, and ureteral dilatation.
• The nomogram aids in patient information, therapeutic strategy, and optimizing postoperative surveillance.