Obstructive Uropathy Secondary to Pelvic Endometriosis: A Scary Story!

Endometriosis presents as-1. superficial, 2. ovarian endometrioma, and 3. deep infiltrating endometriosis. Obstructive uropathy can rarely result from endometriosis, especially in premenopausal women-incidence being 0.3%-12%.

A 40-year-old married, working female presented to ER with severe left-sided flank pain radiating, lump abdomen, heavy menstrual bleeding, and inability to pass urine. Physical examination revealed a large 24-week lump abdomen. Imaging studies were done with USG showing a large cystic left adnexal mass which was followed by CT urography showing hydroureteronephrosis and a large cystic mass of 10 cm compressing the urinary bladder and ureter, along with uterine adenomyosis. Emergency cystoscopy and left DJ stenting was done to relieve the obstruction which resulted in relief from flank pain. This was followed by laparoscopic hysterectomy with left salpingo-oophorectomy with right salpingectomy and adhesiolysis. Postoperative imaging showed complete resolution of ureteral obstruction and hydronephrosis. Histopathology confirmed endometriotic cyst and adenomyosis.

Endometriosis can present with a wide spectrum of symptoms. Involvement of the urinary system in cases of endometriosis might result in compromise of renal function over time. Prompt surgical management is essential in cases of obstructive uropathy. Cases similar to ours have demonstrated the importance of prompt decompression of urinary tract by emergency DJ stenting followed by definitive surgical management of underlying endometriosis. Modern endometriosis management included the conservative laparoscopic surgery and ureterolysis followed by the resection of concomitant endometriosis and a broad-based multidisciplinary approach, centered on a patient's symptoms and priorities.

This case underscores the importance of considering endometriosis as a differential diagnosis of women presenting with urological symptoms as well as the need for collaboration between urologist and gynecologist in such cases solidifying that the rapid intervention and multidisciplinary line of management is essential for optimal patient outcome.