| Objective:To explore the clinical characteristics,diagnosis,treatment and prognosis of patients with ureteral endometriosis,so as to provide some reference for clinicians to make treatment plans for patients with ureteral endometriosis.Methods:The cases of gynecology and urology in Yuncheng Hospital affiliated to Shanxi Medical University and Taiyuan Central Hospital from June 2015 to October 2021 were collected retrospectively.A total of 886 patients with pelvic endometriosis,ovarian chocolate cyst and deep invasive endometriosis were searched by electronic medical record system.28 patients with UE were detected by reading medical history,auxiliary examination,surgical records and pathological diagnosis.Collect the clinical data of patients with UE.Including the patient’s age,medical history(clinical manifestation,time of onset,previous treatment and history of pelvic surgery),laboratory examination(CA125,serum creatinine value),imaging examination(gynecological ultrasound,urinary ultrasound,pelvic MRI,pelvic CT,intravenous pyelography IVP,renogram),operation(mode of operation,surgical exploration)and follow-up(postoperative pathological results,clinical manifestations,postoperative treatment,complications and recurrence).Based on the above data,the clinical features,diagnosis,treatment and prognosis of UE were analyzed retrospectively.Results:28 patients with UE accounted for 3.1% of the total patients with endometriosis in the same period,with an average age of 36.5 years(range: 17 to 52 years).The average time from the onset of clinical symptoms to medical treatment was 17.8 months.21patients(75.0%)had obvious clinical symptoms,dysmenorrhea(40.0%)was still the main clinical manifestation,7 cases(25.0%)had no clinical manifestations,and no periodic hematuria and microscopic hematuria were found in all patients.Five patients had received conservative treatment for endometriosis,and one patient with adenomyosis developed hydronephrosis after 4 years of treatment with levonorgestrel-releasing intrauterine system.Two patients with UE complicated with mild hydronephrosis were treated with Gn RH-a for 6 months and ureteral stent implantation was performed to relieve hydronephrosis.ureteral stents were removed and urological ultrasound showed that hydronephrosis was further aggravated,and 1 case had renal infunction.Thirteen patients(46.4%)had hydronephrosis at the time of treatment,of which 4 cases(14.3%)had no renal function.All the 28 patients underwent laparoscopic surgery with the combination of gynecologists and urologists.UE surgery was performed in 22 cases(78.0%)of ureterolysis,1 case of ureteral segmental resection and bladder replantation,and 4cases of nephrectomy and ureterectomy(14.3%).The postoperative pathological results of 28 patients were consistent with UE,including 26 cases of exogenous UE(92.9%)and 2 cases of endogenous UE(7.1%).Among the 28 patients,3 patients underwent hysterectomy and double adnexal resection on the basis of complete resection of endometrial ectopic lesions.Nineteen patients were treated with gonadotropin releasing hormone agonist(Gn RH-a)within 1 week after operation for 3 to 6 months,and 5 patients were treated with gestrinone within 1 week after operation for 3 to 6 months.1 patient was successfully pregnant 18 months after operation because of short-term fertility requirements.The average follow-up time of all patients was 23.2 months(range5~ 72 months).The pain symptoms were relieved in varying degrees,including complete relief of dysmenorrhea in 2 cases,complete relief of low back pain in 1case,complete relief of sexual intercourse pain in 2 cases and normal blood pressure in 1 case of hypertension.Postoperative hydronephrosis was relieved in all 9 patients,including 1 patient with severe renal function injury who placed ureteral stent on the basis of complete relief of ureteral stricture.Six months after operation,the ureteral stent was removed and renogram was reexamined.There was no significant change in glomerular filtration rate and is still in follow-up.In 4patients with nephrectomy,the contralateral renal function was normal.Nine patients with ureteral stents were removed between 2 and 6 months after operation,and no complications of ureteral fistula occurred so far.All patients were followed up so far without ureteral restenosis.Conclusion:Ureteral endometriosis is rare and has no specific clinical manifestations.Clinicians should improve their understanding of the disease,especially urologists with hydronephrosis in reproductive female patients for the first time,and it should be clear whether it is hydronephrosis caused by UE on the basis of excluding urinary system-related diseases.For patients with endometriosis and adenomyosis who have been conservatively treated with drugs for a long time,while the clinical symptoms are relieved,clinicians should conduct long-term follow-up and,if necessary,urinary ultrasound examination should be performed to determine whether the ureter is involved or not.avoid delayed diagnosis leading to loss of renal function.As soon as UE is diagnosed,it should be treated actively,but the effect of drug treatment is limited and the damage of renal function will be further aggravated in the process of drug treatment.Surgery is the first choice for the treatment of UE.The focus of endometriosis involves the ureter,whether or not ureteral stricture causes hydronephrosis,once it is found that the ectopic focus of ureter or the narrow segment of ureter should be removed thoroughly to relieve urinary system obstruction and avoid further deterioration of renal function.The mode of operation should be individualized according to the preoperative renal function evaluation,intraoperative exploration and the specific conditions of the patients.Ureterolysis was performed in patients with UE without hydronephrosis or mild hydronephrosis on the basis of complete resection of endometriosis.Nephrectomy should be performed for patients with renal dysfunction and urinary symptoms before operation. |
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