Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis

Fertil Steril. 2010 Jan;93(1):46-51. doi: 10.1016/j.fertnstert.2008.09.076. Epub 2008 Nov 5.


Objective: To evaluate prospectively the efficacy of laparoscopic ureterolysis versus ureteroureterostomy in women with ureteral endometriosis.

Design: Prospective study.

Setting: Department of Obstetrics and Gynecology, Ospedale Sacro Cuore of Negrar, Verona, Italy, a tertiary care endometriosis referral center.

Patient(s): Endometriotic patients with moderate-severe ureter dilatation.

Intervention(s): All women underwent laparoscopic endometriosis excision and concomitant laparoscopic ureterolysis, ureteroureterostomy, nephrectomy, or laparotomic ureterocystoneostomy.

Main outcome measure(s): Clinical outcomes were evaluated.

Result(s): Fifty-six patients with preoperative or intraoperative evidence of moderate-severe ureter dilatation were enrolled. Dysmenorrhea (91%) and dyspareunia (68%) were the symptoms more frequently reported; only two patients had typical obstructive uropathy pain. In 35 cases, laparoscopic ureterolysis, in 17 laparoscopic ureteroureterostomy, in 2 laparotomic ureterocystoneostomy, and in 2 laparoscopic nephrectomy was performed. 11 out of 35 (31.4%) major complications occurred in the ureterolysis group, and 2 out of 17 (11.7%) in the ureteroureterostomy group. Median follow-up time was 21 months. Ureteral endometriosis recurrence was surgically detected in three patients who underwent conservative ureteral surgery.

Conclusion(s): Preoperative planning should be rigorous, and complete surgical excision of ureteral endometriosis should be ensured by a team of experts familiar with endometriosis, its multiple manifestations, and its management.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Dilatation, Pathologic
  • Endometriosis / complications
  • Endometriosis / pathology
  • Endometriosis / surgery*
  • Female
  • Humans
  • Hydronephrosis / etiology
  • Hydronephrosis / pathology
  • Hydronephrosis / surgery*
  • Laparoscopy* / adverse effects
  • Nephrectomy* / adverse effects
  • Prospective Studies
  • Recurrence
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Ureter / pathology
  • Ureter / surgery*
  • Ureteral Diseases / complications
  • Ureteral Diseases / pathology
  • Ureteral Diseases / surgery*
  • Ureterostomy* / adverse effects