Outcome of laparoscopic ureterolysis for ureteral endometriosis.
OBJECTIVE
To evaluate the adequacy of laparoscopic ureterolysis as a primary treatment option for ureteral endometriosis.


METHODS
Prospective collaborative cohort study.


METHODS
Gynecologic departments of three university hospitals.


METHODS
Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography.


METHODS
Laparoscopic ureterolysis.


METHODS
Cure rate, disesase recurrence.


RESULTS
Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral ligaments endometriosis in 65.5% (22/34) of cases. No inadvertent ureteral injuries occurred during ureterolysis. A partial wall resection of the ureter was necessary in one case and a segmental ureteral resection with vescicopsoas hitch was required in a women with intrinsic ureteral endometriosis. The median (range) follow-up time was 16 months (range: 3-53 months). Thirty-two patients (96.7%) had a patent ureter on the 3-month postoperative intravenous pyelography. The recurrence rate of ureteral lesions was 12.1% (4/33).


CONCLUSIONS
Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis.
Ghezzi
Fabio
F
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. fabio.ghezzi@uninsubria.it
Cromi
Antonella
A
Bergamini
Valentino
V
Serati
Maurizio
M
Sacco
Alessandro
A
Mueller
Michael D
MD
D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D010535:Laparoscopy; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D014515:Ureteral Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014567:Urography