Urinary tract endometriosis: Revisiting the definition of ureterolysis

To report the incidence of urinary tract endometriosis (UTE) among patients with deep endometriosis, and to analyze surgical procedures, the rate of complications, and the recurrence rate in patients with UTE managed in a French expert center.

We conducted a retrospective analysis of patients treated in the gynecologic surgery department of Tenon Hospital (AP-HP, Paris, France) between January 1, 2016, and December 31, 2022. Patients that underwent partial bladder resection, extensive and complex ureterolysis, or ureteral resection for deep infiltrating endometriosis were selected. We describe surgical approach, type of intervention on urinary tract lesions, associated gynecologic and digestive procedures, and peri- and postoperative complications.

Among 923 patients treated for deep endometriosis, 99 (10.7%) had urinary tract lesions. Bladder surgery was performed in 43 cases (43.4%), including 41 partial cystectomies (41.4%). Ureter procedures were performed in 86 cases (86.9%), including 70 (70.7%) extensive ureterolysis and 16 (16.2%) partial ureteral resections followed by ureteroneocystostomy. Ninety-three patients (94%) underwent standard or robot-assisted laparoscopy. Complications requiring surgical reintervention occurred in 17 cases (17.2%). At 1 month postsurgery, 85% of the patients reported not needing analgesics. During follow up, three patients experienced deep endometriosis recurrence (3%).

Patients with UTE can safely undergo conservative management, with an acceptable complication rate. These patients should be managed in referral centers to favor multidisciplinary approaches, including appropriate preoperative workup.