title: Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification.
abstract: OBJECTIVE
  To analyze the prevalence of urinary tract endometriosis (UTE) in patients with deep infiltrating endometriosis (DIE) and to define potential criteria for preoperative workup.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Six hundred ninety-seven patients with endometriosis.
  
  
  METHODS
  Excision of all endometriotic lesions.
  
  
  METHODS
  Correlation of preoperative features and intraoperative findings in patients with UTE.
  
  
  RESULTS
  Out of 213 patients presenting DIE, 52.6% suffered from UTE. In patients with ureteral endometriosis, symptoms were not specific. Among the patients with bladder endometriosis, 68.8% complained of urinary symptoms compared to 7.9% in the group of patients without UTE. In patients with rectovaginal endometriosis, the probability of ureterolysis showed a linear correlation with the size of the nodule. We found that 3 cm in diameter provided a specific cutoff value for the likelihood of ureteric involvement.
  
  
  CONCLUSIONS
  The prevalence of UTE has often been underestimated. Preoperative questioning is important in the search for bladder endometriosis. The size of the nodule is one of the few reliable criteria in preoperative assessment that can suggest ureteric involvement. We propose a classification of ureteral endometriosis that will allow the standardization of terminology and help to compare the outcome of different surgical treatment in randomized studies.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland. Electronic address: laura.knabben@insel.ch.
authors.forename: Laura
authors.initials: L
authors.lastname: Knabben
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Imboden
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Fellmann
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Nirgianakis
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
authors.forename: Annette
authors.initials: A
authors.lastname: Kuhn
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
mesh_terms: D000328:Adult; D017677:Age Distribution; D004715:Endometriosis / Q000145:classification / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D063189:Symptom Assessment / Q000706:statistics & numerical data; D009626:Terminology as Topic; D014570:Urologic Diseases / Q000145:classification / Q000453:epidemiology* / Q000601:surgery*; D055815:Young Adult
keywords: Deep infiltrating endometriosis; rectovaginal endometriotic nodule; ureteral endometriosis; ureterolysis; urinary tract endometriosis