title: Multidisciplinary team approach to management of severe endometriosis affecting the ureter: long-term outcome data and treatment algorithm.
abstract: OBJECTIVE
  To examine the efficiency of laparoscopic ureterolysis for ureteral endometriosis and to describe appropriate treatment.
  
  
  METHODS
  Prospective trial (Canadian Task Force classification II-2).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty-five patients who underwent surgery to treat ureteral endometriosis between 2005 and 2009.
  
  
  METHODS
  Laparoscopic ureteral ureterolysis.
  
  
  RESULTS
  Long-term follow up of symptoms, urinary tract anatomy and function, and the need for further intervention were performed. Ureteral endometriosis was observed in 14.2% of 315 patients with endometriosis. Of the 45 study patients, 95.5% had dysmenorrhea, 60% had dyspareunia, and 45% were infertile. Half of the patients had previously undergone laparoscopic procedures. Urinary tract symptoms were present in 15.9% of patients. Preoperative hydronephrosis or hydroureter was observed in 10 patients (22.2%), and impaired urinary function in 2 patients (4.4%). Laparoscopy demonstrated left ureteral involvement in 82.2% of patients, and deep infiltrative endometriosis in 80%. Laparoscopic ureterolysis was feasible in 91.1% of patients. In 4 patients, ureterolysis was not feasible, and primary reimplantation of the ureter was performed. Forty-one patients (91.1%) had no symptoms or had marked improvement postoperatively and required no further treatment. Two patients (4.8%) underwent repeat surgery. In 80% of patients with hydroureteronephrosis, the postoperative sonogram was normal.
  
  
  CONCLUSIONS
  Ureteral endometriosis can be treated effectively using laparoscopic ureterolysis in almost all patients. Different treatment approaches should be based on the results of preoperative evaluation and operative findings by a multidisciplinary team. Urinary assessment is crucial because most patients demonstrate no urinary tract symptoms and initial renal investigation can prevent irreversible damage.
authors.affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Soriano
authors.forename: Ron
authors.initials: R
authors.lastname: Schonman
authors.forename: Andrei
authors.initials: A
authors.lastname: Nadu
authors.forename: Oshrit
authors.initials: O
authors.lastname: Lebovitz
authors.forename: Eyal
authors.initials: E
authors.lastname: Schiff
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.forename: Mordechai
authors.initials: M
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D000465:Algorithms; D004715:Endometriosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D010348:Patient Care Team; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000601:surgery*