Ureteral endometriosis: a complication of rectovaginal endometriotic (adenomyotic) nodules

Objective: To present data from 18 cases of ureteral endometriosis. Design: Prospective clinical study. Setting: Department of gynecology at a university hospital. Patient(s): Four hundred and five patients with severe dysmenorrhea or deep dyspareunia due to a rectovaginal endometriotic (adenomyotic) nodule. Intervention(s): Patients were prospectively evaluated using intravenous pyelography. All patients underwent laparoscopic surgery to remove rectovaginal adenomyosis and ureterolysis. Main Outcome Measure(s): Presurgical and postsurgical evaluation and histologic analysis. Result(s): Preoperative intravenous pyelography revealed ureteral stenosis with ureterohydronephrosis in 18 patients (4.4%). A significantly higher prevalence (11.2%) was observed in nodules greater than or equal to3 cm in diameter. Five women (20%) had complete ureteral stenosis. Kidney scintigraphy revealed damaged kidney parenchymal function, which ranged from 18% to 42%. Laparoscopic ureterolysis was done in 16 women; 2 women underwent ureteral resection and uretero-ureterostomy. A significant postoperative decrease in ureterohydronephrosis was noted in all patients; however, renal function improved only slightly. Conclusion(s): Ureteral endometriosis was found in 4.4% of patients with rectovaginal endometriotic (adenomyotic) nodules. Ureterolysis and removal of associated adenomyotic lesions was sufficient therapy in most patients; two required resection of the ureteral stenotic segment. Intravenous pyelography should be performed in all women with rectovaginal nodules greater than or equal to3 cm to prevent nonreversible loss of renal function. (Fertil Steril(R) 2002;77:32-7. (C) 2002 by American Society for Reproductive Medicine.).