title: Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis.
abstract: OBJECTIVE
  To discuss our clinical and surgical experience with 30 cases of ureteral endometriosis.
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-3).
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Records were assessed for all patients who underwent laparoscopic surgery for deep infiltrating endometriosis (DIE) from June 2002 through June 2006. Thirty patients were laparoscopically given a diagnosis that was histologically confirmed of ureteral involvement by endometriosis.
  
  
  METHODS
  Laparoscopic retroperitoneal examination and management of ureteral endometriosis.
  
  
  RESULTS
  Variables assessed were: preoperative findings (patient characteristics, clinical symptoms, preoperative workup), operative details (type and site of ureteral involvement, associated endometriotic lesions, type of intervention, intraoperative complications), and postoperative follow-up (short- and long-term outcomes). We recorded details of 30 patients with a median age of 33.33 years and a median body mass index of 21.96. Symptoms reported were: none in 20 (66.7%) of 30 patients, specific in 10 (33.3%) of 30, dysuria (30%), renal angle pain (10%), hematuria (3.3%), and hydroureteronephrosis (33.3%). Ureteral endometriosis was presumptively diagnosed before surgery in 40% of patients. Ureteric involvement was on the left side in 46.7%, on the right side in 26.7%, and bilaterally in 26.7%. It was extrinsic in 86.7% and intrinsic in 13.3%. It was associated with endometriosis of homolateral uterosacral ligament in all (100%) of 30, the bladder in 50%, rectovaginal septum in 80%, ovaries in 53.3%, and bowel in 36.7%. Laparoscopic intervention was: only ureterolysis in 73.3%, segmental ureteral resection and terminoterminal anastomosis in 16.7%, and segmental ureterectomy and ureterocystoneostomy in 10%. Early postoperative complications were: fever greater than 38 degrees C requiring medical therapy for 7 days in 7 patients and 1 patient had transient urinary retention requiring catheterization that resolved without further treatment. During a mean follow-up period of 14.6 months, endometriosis recurred in 3 patients with no evidence of ureteral reinvolvement.
  
  
  CONCLUSIONS
  Ureteral involvement is a silent, serious complication that must be suspected in all cases of DIE. Retroperitoneal laparoscopic isolation and inspection of both ureters helps to diagnose silent ureteral involvement. Conservative laparoscopic surgery provides a safe, feasible modality for management of ureteral endometriosis.
authors.affiliation: Minimally Invasive Gynecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. renato.seracchioli@aosp.bo.it
authors.forename: Renato
authors.initials: R
authors.lastname: Seracchioli
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mabrouk
authors.forename: Linda
authors.initials: L
authors.lastname: Manuzzi
authors.forename: Manuela
authors.initials: M
authors.lastname: Guerrini
authors.forename: Gioia
authors.initials: G
authors.lastname: Villa
authors.forename: Giulia
authors.initials: G
authors.lastname: Montanari
authors.forename: Elena
authors.initials: E
authors.lastname: Fabbri
authors.forename: Stefano
authors.initials: S
authors.lastname: Venturoli
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000473:pathology; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery