Combined laparoscopic and vaginal approach for nephrectomy, ureterectomy, and removal of a large rectovaginal endometriotic nodule causing loss of renal function.

A late consequence of ureteral endometriosis is the silent loss of renal function caused by progressive "enclosure" of the lower part of the ureter by the endometriosis. In our experience, in cases of severe loss of renal function with cortical atrophy and residual kidney function (evaluated by Tc99 DMSA scintigraphy) of less than 15%, removal of the endometriosis combined with ureterolysis does not allow recovery of renal function. A nonfunctioning kidney associated with hydronephrosis is a risk factor for vascular hypertension, recurrent pyelonephritis, or kidney stones and therefore an indication for nephrectomy. By means of a case report, this paper describes the combination of laparoscopic nephrectomy, ureterectomy, removal of the rectovaginal endometriotic nodule, and extraction of the kidney through the vagina.