Severe ureteral endometriosis: the intrinsic type is not so rare after complete surgical exeresis of deep endometriotic lesions.
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.
Chapron
Charles
C
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
Chiodo
Ilda
I
Leconte
Mahaut
M
Amsellem-Ouazana
Delphine
D
Chopin
Nicolas
N
Borghese
Bruno
B
Dousset
Bertrand
B
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