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

Abstract 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.