title: Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature.
abstract: BACKGROUND
  The ureteral involvement in deep pelvic endometriosis in usually asymptomatic and might lead to a silent loss of renal function. As a matter of fact, the diagnosis and the treatment modalities are still a matter of debate.
  
  
  METHODS
  We performed a literature review by searching the MEDLINE database for articles published in English between 1996 and 2010, using the key words urinary tract endometriosis, ureteral endometriosis, diagnosis and treatment. We found more than 200 cases of ureteral endometriosis (UE).
  
  
  RESULTS
  The disease most commonly affects a single distal segment of the ureter, with a left predisposition in most of the patients. Two major pathological types of UE may be distinguished: intrinsic and extrinsic. The symptoms are usually nonspecific and owing to secondary obstruction. The diagnosis has to be considered as a step- by-step procedure, starting from physical examination to highly detailed imaging methods. Nowadays, the treatment is usually chosen according to the type of UE, the site lesion and the distance to the ureteral orifice, with the use of JJ stents remaining a matter of debate.
  
  
  CONCLUSIONS
  A close collaboration between the gynecologist and the urologist is advisable, especially in referral centers. Surgical treatment can lead to good results in terms of both patient compliance and prognosis.
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy. carmen.maccagnano@gmail.com
authors.forename: Carmen
authors.initials: C
authors.lastname: Maccagnano
authors.forename: Federico
authors.initials: F
authors.lastname: Pellucchi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rocchini
authors.forename: Massimo
authors.initials: M
authors.lastname: Ghezzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011379:Prognosis; D015607:Stents; D014513:Ureter / Q000473:pathology*; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000628:therapy*