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Sutura ureteral profiláctica después de la ureterolisis en endometriosis profunda: descripción de una técnica

Carlo DE Cicco Nardone¹, Maria Cristina Sangiovanni², Francesco Plotti¹

¹Department of Gynecology and Obstetrics, Campus Bio-Medico University Hospital, Rome, Italy.

Minerva obstetrics and gynecology

|February 10, 2026

Resumen

Una nueva técnica laparoscópica, la sutura ureteral profiláctica (PUS), refuerza los uréteres debilitados por la cirugía de endometriosis. Esto evita una reconstrucción mayor, preservando la función renal y la integridad ureteral.

Área de la Ciencia:

Urología Urología Urología.
Cirugía mínimamente invasiva cirugía mínimamente invasiva.
Oncología Ginecológica Oncología Ginecológica.

Sus antecedentes:

La endometriosis profunda puede involucrar extensamente al uréter, lo que lleva a un debilitamiento estructural.
La ureterolisis extensa para la endometriosis profunda puede comprometer la integridad del uréter, con riesgo de estreñimiento o ruptura.
El manejo actual puede requerir resección o reimplantación ureteral, lo que afecta la función nativa.

Objetivo del estudio:

Para describir una nueva técnica laparoscópica, la sutura profiláctica uretral (PUS).
Para reforzar los segmentos ureterales estructuralmente debilitados después de una extensa ureterolisis para la endometriosis profunda.
Para evitar la resección o reimplantación del uréter segmental, preservando la función uretral nativa.

Principales métodos:

La ureterolisis laparoscópica se realizó después de la inserción de un stent ureteral de doble J en pacientes con endometriosis ureteral profunda.
Se identificaron segmentos ureterales estructuralmente comprometidos (sólo mucosas).
Las capas musculares proximales y distales al segmento comprometido se reaproximaron utilizando suturas absorbibles interrumpidas, manteniendo la permeabilidad luminal.

Principales resultados:

La nueva técnica se aplicó a 6 pacientes en un estudio observacional.
No se registraron complicaciones intraoperatorias ni postoperatorias.
La función renal se conservó en todos los pacientes; la obstrucción se resolvió en aquellos con hidronefrosis preoperatoria.

Conclusiones:

La sutura ureteral profiláctica (PUS) ofrece una alternativa conservadora segura y efectiva para la reconstrucción ureteral después de una ureterolisis extensa.
Esta técnica preserva la continuidad ureteral y el mecanismo antirreflujo nativo.
PUS es técnicamente sencillo y se integra con el tratamiento estándar de endometriosis laparoscópica, lo que justifica una mayor investigación para obtener resultados a largo plazo.

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