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      Ureteral stenosis due to DIE (deep infiltrating endometriosis) with difficulty in treatment: Case report and brief literature review

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          Abstract

          Ureteral involvement is rare, with an estimated frequency of 10–14% in cases of deep infiltrating endometriosis. An important complication of ureteral involvement is asymptomatic loss of renal function. We reported that a 49-year-oId woman presented with chronic pelvic pain due to severe dysmenorrhea and without any urological symptoms. Magnetic resonance imaging (MRI) identified a 7 cm endometrioma compressing and infiltrating the rectal wall, and chronic left hydronephrosis. Isotope renogram decreased 14% function in the left kidney. We performed adhesiolysis, freeing of the uterus and appendages, hysterectomy, bilateral oophorectomy. However, we performed only to resect a part of left deep infiltrating endometriosis with ureteral involvement to avoid ureteral injury. After surgery, hydronephrosis was improved and those endometriosis left was not enlarged after 1 years of follow-up. We have to consider bilateral oophorectomy since endometriosis develops by the estrogen-dependent and it may decrease reproductive hormone derived from ovary.

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          Deeply infiltrating pelvic endometriosis: histology and clinical significance.

          J Lauweryns, D Oosterlynck, P Koninckx … (1990)
          In 179 consecutive laparoscopies for infertility (n = 105), pain (n = 60), or both problems (n = 14), endometriosis was diagnosed in 77%, 82%, and 86%, respectively. Eighty implants with positive histology and with careful assessment of depth were sampled by CO2 laser excision from 53 patients. Deep (greater than or equal to 5 mm), intermediate (2 to 4 mm), and superficial (less than 1 mm) infiltration was found in 48%, 35%, and 17% of implants, respectively. Deep infiltration was observed in the pouch of Douglas (55%) and at the uterosacrals (34%), but was absent from the ovarian fossas. Deep implants were found to be active in 68%. At an intermediate depth, however, only 25% of implants were active, whereas 58% of superficial foci showed activity. Deep implants were in phase with the endometrium in 74%. At an intermediate depth, however, only 38% showed regular cyclicity, whereas 57% of superficial implants were in phase with the cycle. Deep infiltration occurred through loose connective tissue septa into the fibromuscular tissue and was always stopped at the underlying fat tissue. Very deep implants (greater than 10 mm) were found exclusively in patients with pain; superficial implants, on the contrary, were found most frequently in patients with infertility (83%).
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            Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis.

            Renato Seracchioli, Mohamed Mabrouk, Linda Manuzzi … (2008)
            To discuss our clinical and surgical experience with 30 cases of ureteral endometriosis. Retrospective analysis (Canadian Task Force classification II-3). Tertiary care university hospital. Records were assessed for all patients who underwent laparoscopic surgery for deep infiltrating endometriosis (DIE) from June 2002 through June 2006. Thirty patients were laparoscopically given a diagnosis that was histologically confirmed of ureteral involvement by endometriosis. Laparoscopic retroperitoneal examination and management of ureteral endometriosis. Variables assessed were: preoperative findings (patient characteristics, clinical symptoms, preoperative workup), operative details (type and site of ureteral involvement, associated endometriotic lesions, type of intervention, intraoperative complications), and postoperative follow-up (short- and long-term outcomes). We recorded details of 30 patients with a median age of 33.33 years and a median body mass index of 21.96. Symptoms reported were: none in 20 (66.7%) of 30 patients, specific in 10 (33.3%) of 30, dysuria (30%), renal angle pain (10%), hematuria (3.3%), and hydroureteronephrosis (33.3%). Ureteral endometriosis was presumptively diagnosed before surgery in 40% of patients. Ureteric involvement was on the left side in 46.7%, on the right side in 26.7%, and bilaterally in 26.7%. It was extrinsic in 86.7% and intrinsic in 13.3%. It was associated with endometriosis of homolateral uterosacral ligament in all (100%) of 30, the bladder in 50%, rectovaginal septum in 80%, ovaries in 53.3%, and bowel in 36.7%. Laparoscopic intervention was: only ureterolysis in 73.3%, segmental ureteral resection and terminoterminal anastomosis in 16.7%, and segmental ureterectomy and ureterocystoneostomy in 10%. Early postoperative complications were: fever greater than 38 degrees C requiring medical therapy for 7 days in 7 patients and 1 patient had transient urinary retention requiring catheterization that resolved without further treatment. During a mean follow-up period of 14.6 months, endometriosis recurred in 3 patients with no evidence of ureteral reinvolvement. Ureteral involvement is a silent, serious complication that must be suspected in all cases of DIE. Retroperitoneal laparoscopic isolation and inspection of both ureters helps to diagnose silent ureteral involvement. Conservative laparoscopic surgery provides a safe, feasible modality for management of ureteral endometriosis.
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              Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images.

              H. K. Ha, Y Lim, H Kim … (1994)
              The purpose of this study was to compare fat-suppressed T1-weighted with conventional MR images for the diagnosis of endometriosis, focusing on the detectability of peritoneal implants, and to evaluate the usefulness of MR imaging in predicting the severity of disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gynecol Minim Invasive Ther
                Journal ID (iso-abbrev): Gynecol Minim Invasive Ther
                Journal ID (publisher-id): GMIT
                Title: Gynecology and Minimally Invasive Therapy
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2213-3070
                ISSN (Electronic): 2213-3089
                Publication date (Print): Oct-Dec 2017
                Publication date (Electronic): 21 July 2017
                Volume: 6
                Issue: 4
                Pages: 214-216
                Affiliations
                [1] Department of Obstetrics and Gynecology, Keio University, Tokyo, Japan
                Author notes
                [* ] Corresponding author. 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-0016, Japan. Fax: +81 3 5363 3578. E-mail address: kuniakiota@ 123456gmail.com (K. Ota).
                Article
                Publisher ID: GMIT-6-214
                DOI: 10.1016/j.gmit.2017.06.007
                PMC ID: 6135202
                PubMed ID: 30254920
                SO-VID: 0ec0ea04-fd99-4e29-996a-3e44f609f251
                Copyright © Copyright: © 2017, The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy
                License:

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 March 2017
                Date revision received : 18 June 2017
                Date accepted : 26 June 2017
                Categories
                Subject: Case Report

                Keywords: deep infiltrating endometriosis,hydronephrosis,laparoscopy,peri-menopausal women
                Data availability:
                Keywords: deep infiltrating endometriosis, hydronephrosis, laparoscopy, peri-menopausal women

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