title: Prevalence and management of urinary tract endometriosis: a clinical case series.
abstract: OBJECTIVE
  To report on the prevalence, surgical management, and outcome of urinary tract endometriosis (UTE) in a cohort of 221 patients undergoing laparoscopic surgery for severe endometriosis. UTE can cause significant morbidity, such as silent kidney or progressive renal function loss. Its frequency is underestimated and data on laparoscopic management are scarce.
  
  
  METHODS
  Between 2007 and 2010, 43 patients were eligible for this single-center, retrospective study. The inclusion criterion was the presence of UTE (ie, bladder and/or ureteral endometriosis). All patients were operated laparoscopically.
  
  
  RESULTS
  The prevalence of UTE was 19.5% (43/221). There was no correlation between bladder and ureteral endometriosis (P >.05). Ureteral endometriosis was associated with patient's age (P <.01). Patients with bladder, but not ureteral, involvement complained more frequently about dysuria, hematuria, and urinary tract infections. Intraoperative and magnetic resonance imaging (MRI) findings revealed a moderate to good correlation. UTE was not associated with rectovaginal or bowel endometriosis, but rather with involvement of the uterosacral ligaments (P <.01). Twenty-two patients with bladder endometriosis were treated by mucosal skinning and 11 patients underwent partial cystectomy. Superficial ureteral excision was performed in 4 patients, whereas resection with ureteroureterostomy was done in 9 patients. There was no difference regarding the intra- and postoperative complications in patients with or without UTE.
  
  
  CONCLUSIONS
  In severe pelvic endometriosis, involvement of the urinary tract is quite common. Laparoscopic management is feasible and safe. Because of the lack of specific symptoms, the preoperative diagnosis of ureteral endometriosis still remains a challenge. Pelvic MRI represents a useful preoperative diagnostic tool.
authors.affiliation: Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France. boris.gabriel@uniklinik-freiburg.de
authors.forename: Boris
authors.initials: B
authors.lastname: Gabriel
authors.forename: Joseph
authors.initials: J
authors.lastname: Nassif
authors.forename: Pantelis
authors.initials: P
authors.lastname: Trompoukis
authors.forename: Sonia
authors.initials: S
authors.lastname: Barata
authors.forename: Arnaud
authors.initials: A
authors.lastname: Wattiez
mesh_terms: D000328:Adult; D000367:Age Factors; D015653:Cystectomy; D053159:Dysuria / Q000209:etiology; D004715:Endometriosis / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D015607:Stents; D014515:Ureteral Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D014519:Ureterostomy; D001745:Urinary Bladder Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D055815:Young Adult