Obstructive uropathy associated with endometriosis

Although endometriosis involving the urinary tract is uncommon, it is responsible for considerable morbidity. A review of eight cases at two Ottawa teaching hospitals from 1979 to 1983 revealed obstructive uropathy in seven patients. There was permanent loss of kidney function in two, ovarian remnant syndrome in two, and patient and family history of renal disease in three. The diagnosis of endometriosis was not made before operation in four patients. Endometriosis was localized in four patients and generalized in the remaining four, while four patients had significant uterosacral nodularity. The conclusion reached after study of this small but important population is that physicians should have a heightened awareness of this uncommon but serious manifestation of the disease. Earlier diagnosis might be achieved on the basis of a high index of suspicion and careful physical and pelvic examination. The liberal use of intravenous pyelography even in cases of minimal endometriosis is urged. Intensive and prolonged follow-up of all patients with the diagnosis of endometriosis is recommended until the menopause has been reached. Treatment of obstructive uropathy requires meticulous surgical intervention and we recommend ovarian ablation with adjuvant hormonal therapy in most circumstances.