title: Hematoureter due to endometriosis.
abstract: OBJECTIVE
  To report the laparoscopic management of a rare case of hematoureter due to endometriosis in a young woman with multiple genitourinary anomalies.
  
  
  METHODS
  Video demonstration of a surgical technique and review of genitourinary endometriosis.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  A 17-year-old nulliparous woman with multiple genitourinary anomalies presented with pelvic pain and unilateral retroperitoneal mass. The patient had uterine didelphys, a history of left nephrectomy, and partial ureter resection as an infant. She had a partial resection of a left transverse vaginal septum due to hematocolpos at age 12. A preoperative magnetic resonance imaging (MRI) scan revealed a left retroperitoneal mass with extension to the paravesical region, reaccumulation of the hematocolpos behind the partially resected left transverse vaginal septum, and a dilated left uterine horn with hematometra.
  
  
  METHODS
  Laparoscopic management of hematoureter due to intrinsic endometriosis.
  
  
  METHODS
  Intraoperative findings showed uterus didelphys with dilated left horn, normal right horn, and normal right and left fallopian tubes and ovaries. The left transverse vaginal septum was resected vaginally, and the hematocolpos and hematometra drained. The left uterine horn and cervix were laparoscopically resected. The left-side serpiginous retroperitoneal mass was dissected from the pelvic sidewall, ligated, and transected, with spillage of thick, brown liquid. The pathology of the mass wall was smooth muscle and transitional epithelium consistent with ureter, in addition to hemorrhage and glandular structures consistent with endometriosis. Endometriosis was also present in the serosa of the left uterine horn. Thus, the left retroperitoneal mass was the left ureter remnant, which acquired endometriosis and collected menstrual debris, resulting in hematoureter.
  
  
  CONCLUSIONS
  Two major pathologic types of ureteral endometriosis have been described: intrinsic, as occurred in this patient, and extrinsic. Women with müllerian anomalies, vaginal obstruction, or imperforate hymen are at higher risk of endometriosis. Prior urogenital surgery can further complicate and distort the anatomy. Thus, a preoperative understanding of the patient's urogenital anomalies is important to consider the differential diagnoses and anticipate surgical needs.
authors.affiliation: Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia. Electronic address: nlakhi@yahoo.com.
authors.forename: Nisha
authors.initials: N
authors.lastname: Lakhi
authors.affiliation: Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Dun
authors.affiliation: Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia.
authors.forename: Ceana H
authors.initials: CH
authors.lastname: Nezhat
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006399:Hematocolpos / Q000150:complications; D006409:Hematometra / Q000150:complications; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D017699:Pelvic Pain / Q000209:etiology; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery; D014515:Ureteral Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014564:Urogenital Abnormalities / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013520:Urologic Surgical Procedures
keywords: Endometriosis; hematoureter; laparoscopy; müllerian anomalies