Kunlin Yang1,2,3, Sida Cheng1,2,3, Yukun Cai1,2,3, Jiankun Qiao1,2,3, Yangyang Xu1,2,3, Xinfei Li1,2,3, Shengwei Xiong1,2,3, Ye Lu4, Aobing Mei5, Xuesong Li6,7,8, Liqun Zhou1,2,3. 1. Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. 2. Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. 3. National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. 4. Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. 5. Department of Urology, The Second People's Hospital of Guiyang, Guizhou, China. meiaobing@163.com. 6. Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. pineneedle@sina.com. 7. Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. pineneedle@sina.com. 8. National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. pineneedle@sina.com.
Abstract
BACKGROUND: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. METHODS: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. RESULTS: Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a 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 (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (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 nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the 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). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. CONCLUSIONS: Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.
BACKGROUND: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. METHODS: To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. RESULTS: Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a 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 (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (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 nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the 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). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. CONCLUSIONS: Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.
Entities:
Keywords:
Case report; Nephroureterectomy; Ureteralendometriosis; Ureteroneocystostomy; Ureteroureterostomy