Identification of an Intraperitoneal Ureter After Ureterolysis
We present the case of a 29 year-old G0 with a past history of ureteral obstruction and hydroureteronephrosis due to deeply infiltrating endometriosis requiring left ureterolysis, complete left parametrectomy, and left salpingo-oophorectomy. She now presents with recurrent pelvic pain and a new right adnexal mass consistent with an endometrioma requiring surgical intervention.
AbstractDeeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may c...
To identify and highlight preservation of the ureter and hypogastric nerve during excision of superficial endometriosis for the treatment of chronic pelvic pain.
CONCLUSIONIn all endometriosis cases which require surgery will need to be performed by an experienced operator. If rectovaginal endometriosis nodule was unexpectedly found during intraoperative and recognition of rectum and ureter must be done, knowledge of retroperitoneal anatomy is required.
ConclusionExtreme cases of DIE involving the pelvic side wall require surgical finesse when normal planes of dissection are obliterated. Knowledge of retroperitoneal anatomy is critical in order to overcome unexpected lateral pelvic side wall endometriosis as the disease is rarely confined to the surface. Innovative surgical thinking complemented by an array of surgical tools will ultimately allow the surgeon to master these difficult endometriotic resections.
Conclusion We encourage collaborative care for planning and performing comprehensive and safe resection of deeply infiltrative endometriosis.
Abstract IntroductionTo evaluate the accuracy of transvaginal sonography for preoperative detection of bladder endometriosis and surgical outcomes regarding fertility and pain symptoms of women with urinary tract endometriosis. Material and methodsRetrospective cohort study of consecutive patients with urinary tract endometriosis undergoing laparoscopic partial cystectomy and/or ureterolysis/decompression, ureteric resection and end‐to‐end anastomosis or ureteroneocystostomy for ureteral stenosis and hydronephrosis. ResultsOf 207 patients with deep infiltrating endometriosis, 50 exhibited urinary tract endometriosis, c...
ConclusionsThe nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.
Abstract IntroductionTo evaluate the accuracy of transvaginal sonography for preoperative detection of bladder endometriosis and surgical outcomes regarding fertility and pain symptoms of women with urinary tract endometriosis. Material and MethodsRetrospective cohort study of consecutive patients with urinary tract endometriosis undergoing laparoscopic partial cystectomy and/or ureterolysis/decompression, ureteric resection and end‐to‐end anastomosis or ureteroneocystostomy for ureteral stenosis and hydronephrosis. ResultsOut of 207 patients with deep infiltrating endometriosis, 50 exhibited urinary tract endometriosi...
Endometriosis is a common disease associated with chronic pelvic pain and infertility. For ureteral endometriosis, which is rare, conventional therapy previously consisted of laparotomy. However, laparoscopic ureteroneocystostomy has been reported recently. Laparoscopic surgery for ureteral endometriosis requires greater surgical expertise and takes a longer time to master. The minimally invasive approach is well known to give patients benefits because of its small incision, less pain and shorter hospital stay.
Endometriosis may affect the urinary tract in up to 6% of cases. This video describes a laparoscopic approach to the excision of endometriosis overlying the ureter. We demonstrate a retroperitoneal pelvic sidewall dissection in a patient with pelvic pain who desired conservative surgical management of her endometriosis. The ureter is identified and followed through its course in the pelvis. Relevant nearby structures, including the umbilical artery, uterine artery, and iliac arteries, are clearly seen.