Outcome of laparoscopic ureterolysis for ureteral endometriosis

Objective: To evaluate the adequacy of laparoscopic ureterolysis as a primary option for uretral endometriosis. Design: Prospective collaborative cohort study. Setting: Gynecologic departments of three university hospitals. Patient(s): Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography. Intervention(s): Laparoscopic ureterolysis. Main Outcome Measure(s): Cure rate, disease recurrence. Result(s): Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral endometriosis in 65.5% (22/34) of cases. No inadvertent uretral injuries occurred during ureterolysis. A partial wall restriction of the ureter was necessary in one case and a segmental uretral resection with vescicopsoas hitch was required in a women with intrinsic uretral endometriosis. The median (range) follow-up time was 16 months (range: 5-53 months). Thirty-two patients (96.7%) had a patent ureter on the 3 month postoperative intravenous pyelography. The recurrence rate of uretral lesions was 12.1% (4/33). Conclusion(s): Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with uretral endometriosis exhibiting moderate-to-severe hydronephrosis.