Clinical aspects and surgical treatment of urinary tract endometriosis: our experience with 31 cases.
OBJECTIVE
To present and discuss clinical and surgical management of urologic endometriosis.


METHODS
Retrospective review of a database on surgical patients with endometriosis.


RESULTS
Thirty-one patients (incidence, 2.6%; mean age, 33.1 yr) were affected by urologic endometriosis (bladder, 12; ureter, 15; both, 4). Bladder endometriosis was revealed by symptoms related to menses and showed a typical endoscopic picture, whereas ureteral involvement had a nonspecific or silent symptomatology. All patients affected by bladder endometriosis and undergoing transurethral resection (2 cases) developed a bladder recurrence; a ureteral recurrence was observed in two of six patients submitted to laparoscopic ureterolysis and in one of two patients submitted to ureterectomy with ureteroureterostomy. Conversely, no relapses were observed among the 14 patients who had partial cystectomy or the 9 who had ureterectomy and ureterocystoneostomy. Finally, two patients underwent nephrectomy due to end-stage renal atrophy.


CONCLUSIONS
Cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms; the upper urinary tract should be evaluated in all patients with pelvic endometriosis to exclude asymptomatic ureteral involvement. Partial cystectomy gives the best results when used to treat bladder endometriosis. Ureterolysis can be successful only in case of limited ureteral involvement with no urinary obstruction, whereas terminal ureterectomy and ureterocystoneostomy should be preferred in case of obstructive ureteral endometriosis.
Antonelli
Alessandro
A
Chair and Department of Urology, University of Brescia, Italy. alxanto@hotmail.com
Simeone
Claudio
C
Zani
Danilo
D
Sacconi
Tazio
T
Minini
Gianfranco
G
Canossi
Emma
E
Cunico
Sergio Cosciani
SC
D000328:Adult; D004715:Endometriosis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000601:surgery*