Pelvic endometriosis and ureteral obstruction.

Pelvic endometriosis may completely obstruct the ureters and destroy the kidneys with little or no gynecologic symptoms. Five cases are discussed, all causing ureteral obstruction. Two patients suffered the complete loss of a kidney and in each case the remaining kidney was in jeopardy because of partial obstruction due to endometriosis. All these patients were treated by complete removal of all ovarian tissue, dissection of the ureter, and dissection of the scar tissue. In severe cases, retroperitoneal clamping of the infundibular pelvic ligament with clear exposure of the ureter is mandatory to avoid leaving small remnants of ovary in the infundibular ligament clamp. With complete removal of all ovarian tissue, postoperative estrogen therapy will not cause recurrence of the disease.