Ureteral abnormalities in women with endometriosis

Wayne S. Maxson; George A. Hill; Carl M. Herbert; Alan J. Kaufman; Donald E. Pittaway; James F. Daniell; Alan C. Winfield; Anne Colston Wentz

doi:10.1016/s0015-0282(16)49900-0

Endometriosis Associated Conditions

Ureteral abnormalities in women with endometriosis

Maxson WS, Hill GA, Herbert CM, Kaufman AJ, Pittaway DE, Daniell JF, Winfield AC, Wentz AC

Published December 1986 Fertility and Sterility, 46(6), 1159-1161

DOI 10.1016/s0015-0282(16)49900-0 PMID 3781030

RRM Academy Synopsis

Subtle ureter abnormalities found in 16% of women with endometriosis

Subtle ureter abnormalities appeared in about 16 out of 100 women with endometriosis, against about 1 out of 100 healthy kidney donor candidates. A 1986 Vanderbilt study imaged 63 women with surgically proven endometriosis before treatment. None had urinary symptoms or a blocked ureter.

Key Findings

Ten of 63 women with endometriosis (15.9%) had ureteral abnormalities believed to be caused by endometriosis, compared with 1 of 84 control women (1.2%) (chi-square = 11.21, P < 0.001).
Imaging showed the ureter pressed from outside, kinked, or narrowed within 5 cm of the bladder junction. The left side was involved every time; one woman had both.
No woman with endometriosis had urologic symptoms, and none showed hydroureter or ureteral obstruction on the urography.
Abnormal urography occurred in 6 of 14 women (43%) with severe endometriosis (AFS score > 15) and in 4 of 49 (8%) with mild or moderate disease (AFS score < 15).
Women with abnormal urography had higher mean endometriosis scores than women with normal urography (16.0 ± 2.9 versus 9.5 ± 1.0, P < 0.02).

Interpretation

The study imaged women with endometriosis before treatment. Its comparison group was 84 healthy kidney donor candidates, reviewed after the fact. Abnormal findings were more common with endometriosis and rose with disease severity. The authors call the comparison group less than ideal, since donors received a lower contrast volume. The women averaged 29.9 years, and most sought care for infertility. The authors support imaging before definitive therapy in severe endometriosis, with repeat imaging when the ureter is involved.

RRM Context

The authors call silent progression of endometriosis a serious threat. Women in this study had no urinary symptoms, yet some had ureter changes. Restorative reproductive medicine looks for the root cause and the full extent of disease, beyond the symptoms a woman describes.

Our editorial summary of this paper, not the article's abstract.

Abstract

High-volume intravenous urography was performed in 63 women with surgically proven endometriosis. Subtle abnormalities were found in 15.9% of these women. No patient had urologic symptoms, and there was no evidence of hydroureter or ureteral obstruction on the IVP. Long-term follow-up study will be required to determine whether or not these lesions will progress and cause ureteral obstruction.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read

Topics

Endometriosis

Associated Conditions Extrapelvic Endometriosis

Endometriosis › Associated Conditions › Extrapelvic Endometriosis

Wayne S. Maxson, George A. Hill, Carl M. Herbert, Alan J. Kaufman, Donald E. Pittaway, James F. Daniell, Alan C. Winfield, Anne Colston Wentz

W Maxson, G Hill, C Herbert, A Kaufman, Don Pittaway, D Pittaway, Jim Daniell, Jimmy Daniell, J Daniell, A Winfield, A Wentz

PMID 3781030 3781030 DOI 10.1016/s0015-0282(16)49900-0 10.1016/s0015-0282(16)49900-0 Maxson et al. 1986, Maxson 1986

Keywords

Adult, Endometriosis/complications, Female, Humans, Parity, Prospective Studies, Ureter/abnormalities/diagnostic Imaging, Urography, Uterine Neoplasms/complications

Ureteral abnormalities in women with endometriosis

Subtle ureter abnormalities found in 16% of women with endometriosis

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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Keywords