Outcomes Of Surgical Management Of Ureteral Endometriosis: Retrospective Analysis Of 24 Cases

Purpose:Evaluate preoperative findings, surgical details and outcomes of surgical management of ureteral endometriosis.Methods:A retrospective study was performed on 24 women who underwent ureteral surgery for ureteral endometriosis. Measurements included results of clinical and instrumental assessment, operative complications, and symptoms related to endometriosis and uro-specific pain.Results:Concomitant renal dilatation was present in 10 women, while, in the other 14 cases, endometriotic lesions were close to or surround ureter but did not cause hydronephrosis. Ureterolysis was performed in all women who underwent surgical treatment of ureteral endometriosis, among which,12 cases proceed with resection of an endometriotic segment of the ureter. Since endometriotic lesions were located in the distal ureter,6 patients underwent ureteral resection combined with ureteroneocystostomy. As the lesions in the middle ureter,6 patients underwent ureteroureteral anastomosis. With a median follow-up of 25(11-154) months, post-operative symptomatology was improved for dysmenorrhea, dyspareunia and abnormal vaginal bleeding.Conclusions:The aim of surgery for ureteral endometriosis is to resolve the stenosis and to preserve renal function. We believe that ureterolysis is the first choice for ureteral endometriosis without hydronephrosis. However, in cases with moderate to severe hydronephrosis, segmental ureterectomy is feasible. Both conservative and radical surgeries had good outcomes at long-term follow-up.