title: Endoscopic management of intraluminal ureteral endometriosis.
abstract: OBJECTIVE
  To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation.
  
  
  METHODS
  We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser. Patients were monitored for evidence of disease persistence, recurrence, or progression with computed tomography, sonography, renal scan, ureteroscopy, and retrograde urography. Success was defined as the complete eradication of ureteral endometriosis, resolution of symptoms, and maintenance of renal function.
  
  
  RESULTS
  Five patients were identified. Mean age was 37.5 years. All patients had hydroureteronephrosis at presentation whereas 2 had severely impaired renal function. Three patients were successfully treated with a single ablative procedure, whereas 2 had persistent symptomatic hydroureteronephrosis and underwent repeat ablation. Of those requiring repeat ablation, 1 became disease-free after the second ablation, whereas the other had persistence of disease, requiring nephroureterectomy. Three patients developed ureteral strictures, requiring balloon dilation and serial stent exchanges. At a median follow-up of 35 months (16-84), overall success rate was observed in 4 of 5 patients (80%).
  
  
  CONCLUSIONS
  Endometriosis affects approximately 15% of premenopausal women and can present anywhere along the urinary tract including the ureters, which might result in urinary obstruction and impaired renal function. Although surgical resection is the conventional treatment option for intraluminal endometriosis, ureteroscopic management is a viable nephron-sparing alternative. Follow-up imaging, including ureteroscopic surveillance and retrograde urography is recommended to detect disease recurrence or progression, or both.
authors.affiliation: Department of Urology, Columbia University Medical Center, NY, USA.
authors.forename: Crystal V
authors.initials: CV
authors.lastname: Castaneda
authors.forename: Edan Y
authors.initials: EY
authors.lastname: Shapiro
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Ahn
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.forename: Mark V
authors.initials: MV
authors.lastname: Silva
authors.forename: Yungkhan
authors.initials: Y
authors.lastname: Tan
authors.forename: Mantu
authors.initials: M
authors.lastname: Gupta
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D009392:Nephrectomy; D012189:Retrospective Studies; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy