title: Severe ureteral endometriosis: the intrinsic type is not so rare after complete surgical exeresis of deep endometriotic lesions.
abstract: OBJECTIVE
  To evaluate the rate of intrinsic ureteral endometriosis in patients presenting with severe ureteral endometriosis.
  
  
  METHODS
  Observational study between June 1992 and December 2007.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  Twenty-nine patients presenting deeply infiltrating endometriosis (DIE) with severe ureteral endometriosis. Severe ureteral endometriosis was defined as DIE lesions causing significant obstruction to the urinary flow with ureteral stenosis.
  
  
  METHODS
  Complete surgical exeresis of DIE lesions.
  
  
  METHODS
  Pre- and peroperative evaluation associated with histologic analysis. Intrinsic ureteral endometriosis was defined as presence of DIE lesions infiltrating the ureteral muscularis.
  
  
  RESULTS
  In a series of 627 patients with histologic proved DIE, we observed 29 (4.6%) patients with severe ureteral endometriosis. Ureteral lesions (n = 34) were right sided in 7 (24.1%) patients, left sided in 17 (58.6%) patients, and bilateral in 5 (17.3%) patients. Eleven (37.9%) patients presented intrinsic lesions. Out of the 34 ureteral lesions 13 (38.2%) were intrinsic. In cases of radical ureteral surgery (n = 21 patients; n = 24 ureteral lesions) intrinsic ureteral DIE was observed in 52.4% (11 cases) of the patients and in 54.2% (13 cases) of the ureteral lesions.
  
  
  CONCLUSIONS
  The prevalence of intrinsic ureteral endometriosis is underestimated. This result must be taken into account when specifying the surgical modalities for patients presenting with severe ureteral endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology II and Reproductive Medicine, Université Paris Descartes, Assistance Publique, Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin Saint Vincent de Paul, Paris, France. charles.chapron@cch.aphp.fr
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
authors.forename: Ilda
authors.initials: I
authors.lastname: Chiodo
authors.forename: Mahaut
authors.initials: M
authors.lastname: Leconte
authors.forename: Delphine
authors.initials: D
authors.lastname: Amsellem-Ouazana
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chopin
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010049:Ovarian Diseases / Q000150:complications / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014515:Ureteral Diseases / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods