Urinary tract endometriosis is the 2nd most common form of extra-pelvic endometriosis (after gastrointestinal tract endometriosis).
Urinary bladder is affected in 85% of the cases and the ureter in 10%.Ureteral endometriosis can be either intrinsic in 40% of the cases (the disease grows inside the wall of the ureter) or extrinsic in 60% of the cases (the nodule presses the wall of the ureter from the outside).Most of the times,ureteral endometriosis is asymptomatic (50%) whereas in certain circumstances can appear as flank pain (25%) or haematuria (15%).The previous symptoms can sometimes be combined with with dysmenorrhea (pain during menses) or/and dyspareunia (pain during sexual intercourse).
Ureteral endometriosis can have devastating sequence among which the most serious is loss of kidney fuction (silent kidney loss).In such circumstances ,imaging of the urinary tract is crucial and is considered as an emergency.Other symptoms that may indicate ureteral endometriosis include repeated urinary infections,increased urinary frequency,dysuria (pain during urination) and haematuria (blood seen in the urine).Ureteral endometiosis usually presents as a dilatation of the ureter.In such cases the disease is expected to be extended involving one or more of the following : bowel, ligaments,cervic,vagina,rectovaginal septum etc.
Since there is no medical treatment that can deal with such a situation,the surgical removal of endometriosis and decompression of the ureter’s obstruction is mandatory.
Surgical treatment of ureteral endometriosis is often a challenge for the endometriosis surgeon as it can be very complicated and requires relevant experience and multidisciplinary team approach.Our team has successfully accomplished a big number of such cases managing to save kidney’s function.