Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 2 , Pages 142-145, June 2006

Failure of Laparoscopy to Relieve Ureteral Obstruction Secondary to Endometriosis

  • Hsing-Yu Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Ming-Chao Huang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Ming-Chao Huang, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan
    • ,
  • Yu-Chung Hung

      Affiliations

    • Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Yung-Hsuen Hsu

      Affiliations

    • Department of Nephrology, Taipei City Union Hospital, Taipei, Taiwan

Accepted 18 October 2005.

Article Outline

Summary 

Objective

To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management.

Case Report

A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis.

Conclusion

In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.

Key Words:  endometriosis , laparoscopy , ureteral obstruction

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References 

  1. Klein RS , Cattolica EV . Ureteral endometriosis . Urology . 1979;13:477–482
  2. Adamson GD . Diagnosis and clinical presentation of endometriosis . Am J Obstet Gynecol . 1990;162:568–569
  3. Denes FT , Pompeo ACL , Momtelatto NID , Lopes RN . Ureteral endometriosis . Int Urol Nephrol . 1980;12:205–209
  4. Chapron C , Dubuisson JB . Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments . Hum Reprod . 1996;11:868–873
  5. Cornillie FJ , Oosterlynck D , Lauwereyns JM , Koninckx PR . Deeply infiltrating endometriosis: histological and clinical significance . Fertil Steril . 1990;53:978–983
  6. Koninckx PR , Meuleman C , Demeyere S , et al.   Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain . Fertil Steril . 1991;55:759–765
  7. Moore JG , Hibbard LT , Growdon WA , Schifrin BS . Urinary tract endometriosis: enigmas in diagnosis and management . Am J Obstet Gynecol . 1979;134:162–172
  8. Davis OK , Schiff I . Endometriosis with unilateral ureteral obstruction and hypertension. A case report . J Reprod Med . 1988;33:470–472
  9. Carbognin G, Guarise A, Minelli L, Vitale I, Malago R, Zamboni G, et al. Pelvic endometriosis: US and MRI features . Abdom Imaging . 2004;29:609–618
  10. Zanardi R , Del Frate C , Zuiani C , Del Frate G , Bazzocchi M . Staging of pelvic endometriosis using magnetic resonance imaging compared with the laparoscopic classification of the American Fertility Society: a prospective study . Radio Med . 2003;105:326–328
  11. Ha HK , Lmi YT , Kim HS , Suh TS , Song HH , Kim SJ . Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images . AJR Am J Roentgenol . 1994;163:127–131
  12. Rivlin ME , Miller JD , Krueger RP , Patel RB , Bower JD . Leuprolide acetate in the management of ureteral obstruction caused by endometriosis . Obstet Gynecol . 1990;75:532–536
  13. Jepsen JM , Hansen KB . Danazol in the treatment of ureteral endometriosis . J Urol . 1988;139:1045–1046

PII: S1028-4559(09)60212-6

doi:10.1016/S1028-4559(09)60212-6

Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 2 , Pages 142-145, June 2006

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