Rate of Recurrent Hydronephrosis After Laparoscopic Ureteroneocystostomy for Ureteral Endometriosis

Study Objective: To investigate the short-term outcomes of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis (UE).Design: Retrospective cohort study of consecutive patients who underwent surgery for the ureter endometriosis with hydronephrosis.Setting: A private hospital that provide primary, secondary and tertiary care.Patients: 30 consecutive patients with UE who underwent laparoscopic ureteroneocystostomy at our institution between May 2008 and April 2020. Interventions: Laparoscopic ureteroneocystostomy, if necessary, hysterectomy, salpingo-oophorectomy, cystectomy, partial bladder resection, or partial bowel resection were performed.Measurements and Main Results: The most common chief complaint was pelvic pain (40%). Endometriosis affected only the left ureter in 56.7% of patients, only the right ureter in 33.3%, and both ureters in 6.7%. Involvement of the ipsilateral ovary was confirmed in 64.3%. The most frequent location of UE was 1 to 3 cm above the UVJ (46.7%). A psoas hitch was performed in 7 patients (23.3%), and the Boari flap was used in 9 patients (30%). Hysterectomy was performed in 12 patients (40%), and 6 of them had a concomitant bilateral salpingo-oophorectomy (20%). In addition, 3 patients (10%) underwent partial bowel resection, and 2 patients (6.7%) underwent partial bladder resection. After surgery, 24 of 27 patients (80.0%) were free of sever hydronephrosis after surgery. Hydronephrosis recurred in a single patient (3.3%), but the grade of hydronephrosis improved significantly after surgery (P<.001). At 6 months of follow up, 4 patients (13.3%) experienced urinary tract infections and 2 patients (6.7%) reported dysuria. Patients reported a regression of dysmenorrhea symptoms (P<.001). Conclusion: This study shows that ureteroneocystostomy provides good results in terms of relapses and symptoms’ control in patients with ureteral endometriosis.

Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases

Background To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. Methods To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. Results Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. Conclusions Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.

Clinical Characteristics and Surgical Treatment of Ureteral Endometriosis: Our Experience with 40 Cases

Background: To present the experience of surgical management of ureteral endometriosis (UE) in our single center.Methods: A retrospective analysis of 40 cases of UE who had intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE.Results: Forty patients (median age, 42.5 years) with histologic evidence of UE were included. Six (15%) patients had history of endometriosis. Twenty-one (52%) patients had urological symptoms and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate of the affected-side kidney was significantly worse than the healthy-side one (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephoureterectomy. One patient refused the aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) cases were required gynecological operations. Three (8%) patients in open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). The success rate was 25/28 (89%).Conclusions: Although UE is rare, early diagnosis and treatment of UE will help reduce the morbidity of this disease. Most of time, A multidisciplinary team is necessary. For the patients with severe UE, segmentally ureteral resection with UU or ureteroneocystostomy may be a good choice.