title: Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis.
abstract: OBJECTIVE
  To evaluate prospectively the efficacy of laparoscopic ureterolysis versus ureteroureterostomy in women with ureteral endometriosis.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Department of Obstetrics and Gynecology, Ospedale Sacro Cuore of Negrar, Verona, Italy, a tertiary care endometriosis referral center.
  
  
  METHODS
  Endometriotic patients with moderate-severe ureter dilatation.
  
  
  METHODS
  All women underwent laparoscopic endometriosis excision and concomitant laparoscopic ureterolysis, ureteroureterostomy, nephrectomy, or laparotomic ureterocystoneostomy.
  
  
  METHODS
  Clinical outcomes were evaluated.
  
  
  RESULTS
  Fifty-six patients with preoperative or intraoperative evidence of moderate-severe ureter dilatation were enrolled. Dysmenorrhea (91%) and dyspareunia (68%) were the symptoms more frequently reported; only two patients had typical obstructive uropathy pain. In 35 cases, laparoscopic ureterolysis, in 17 laparoscopic ureteroureterostomy, in 2 laparotomic ureterocystoneostomy, and in 2 laparoscopic nephrectomy was performed. 11 out of 35 (31.4%) major complications occurred in the ureterolysis group, and 2 out of 17 (11.7%) in the ureteroureterostomy group. Median follow-up time was 21 months. Ureteral endometriosis recurrence was surgically detected in three patients who underwent conservative ureteral surgery.
  
  
  CONCLUSIONS
  Preoperative planning should be rigorous, and complete surgical excision of ureteral endometriosis should be ensured by a team of experts familiar with endometriosis, its multiple manifestations, and its management.
authors.affiliation: Department of Obstetrics and Gynecology, Ospedale Sacro Cuore di Negrar, Verona, Italy. liliana_mereu@yahoo.com
authors.forename: Liliana
authors.initials: L
authors.lastname: Mereu
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Gagliardi
authors.forename: Roberto
authors.initials: R
authors.lastname: Clarizia
authors.forename: Paride
authors.initials: P
authors.lastname: Mainardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Landi
authors.forename: Luca
authors.initials: L
authors.lastname: Minelli
mesh_terms: D000328:Adult; D004108:Dilatation, Pathologic; D004715:Endometriosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D009392:Nephrectomy / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014515:Ureteral Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014519:Ureterostomy / Q000009:adverse effects