Reversal of Endometriosis-Induced Unilateral Ureteral Obstruction and Hydronephrosis With Medical Therapy

Endometriosis is a common condition among women of reproductive age worldwide, with the urinary tract being the second most frequently affected extragenital organ system, particularly the bladder and ureters. Ureteral endometriosis (UE) is relatively rare, often asymptomatic, and can lead to progressive renal function loss if not addressed promptly. Early diagnosis and intervention are essential, requiring a high index of suspicion. We present a case of UE in a patient who experienced moderate dysmenorrhea and back pain. Imaging revealed left-sided moderate hydronephrosis and ureteral dilation, suggestive of endometriosis. After a comprehensive consultation, the patient was treated with goserelin. Following three months of regular monitoring, the hydronephrosis and ureteral dilation resolved. She then transitioned to dienogest for six months, followed by the insertion of a levonorgestrel-releasing intrauterine system. This case highlights the effectiveness of hormonal treatments in managing UE, particularly in patients with mild to moderate symptoms who aim to preserve fertility.