Outcomes of surgical management of deep infiltrating endometriosis of the ureter and urinary bladder.
OBJECTIVE
To report the outcomes of surgical management of urinary tract endometriosis and discuss the choice between conservative and radical surgery.


METHODS
We reviewed data concerning women managed for ureteral or bladder deep infiltrating endometriosis  in 5 surgical departments participating in the CIRENDO prospective database. Preoperative data, surgical procedure data, and postoperative outcomes were analyzed.


RESULTS
Data from 30 women pooled in the database showed 15 women presenting with ureteral endometriosis, 14 women  with bladder nodules, and 1 with both types of lesions. Ureterolysis was performed in 14 cases; the ureter was satisfactorily freed in 10 of these. In 4 women over 40 years old, who were undergoing definitive amenorrhea, moderate postoperative ureteral stenosis was tolerated and later improved  in 3 cases, while the fourth underwent secondary ureteral resection and ureterocystoneostomy. Primary ureterectomy was carried out in 4 women. Two cases of intrinsic ureteral endometriosis were found in 5 ureter specimens. Four complications were related to surgical procedures on ureteral  nodules, and 2 complications followed the removal of bladder endometriosis. Delayed postoperative outcomes were favorable with a significant improvement in painful symptoms and an absence of unpleasant urinary complaints, except for one patient with prolonged bladder denervation.


CONCLUSIONS
Conservative surgery, in association with postoperative amenorrhea, can be proposed in a majority of cases of urinary tract endometriosis. Although the outcomes are generally favorable, the risk of postoperative complications should not be overlooked, as surgery tends to be performed in conjunction  with other complex procedures such as colorectal surgery.
Department of Gynecology and Obstetrics, University Hospital, TârguMure, Romania.
Francisc
F
Rozsnyai
Horace
H
Roman
Benoit
B
Resch
Fabrice
F
Dugardin
Juan
J
Berrocal
Gérôme
G
Descargues
Remi
R
Schmied
Malik
M
Boukerrou
Loïc
L
Marpeau
D000328:Adult; D003952:Diagnostic Imaging; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000175:diagnosis / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000601:surgery*