Urinary tract endometriosis treated by laparoscopy

Camran Nezhat; Farr Nezhat; Ceana H. Nezhat; Fariba Nasserbakht; Maurizio Rosati; Daniel S. Seidman

doi:10.1016/s0015-0282(16)58683-x

Endometriosis Surgical Treatment

Urinary tract endometriosis treated by laparoscopy

Nezhat C, Nezhat F, Nezhat CH, Nasserbakht F, Rosati M, Seidman DS

Published December 1996 Fertility and Sterility, 66(6), 920-924

DOI 10.1016/s0015-0282(16)58683-x PMID 8941055

RRM Academy Synopsis

Laparoscopic surgery treated severe bladder and ureter endometriosis

20 out of 21 women with severe ureter endometriosis reported pain relief after laparoscopic surgery. A 1996 case series from one center followed 28 women with severe bladder or ureter disease. Follow-up lasted 5 to 33 months. One woman had a complication.

Key Findings

Of 2,226 women treated for endometriosis from October 1989 to September 1994, 28 (1.3%) had severe urinary tract endometriosis: 7 in the bladder, 21 in the ureter.
Seventeen women had partial ureter obstruction and 4 had complete obstruction. All 4 with complete obstruction had segmental ureter resection.
Six of the 7 women with bladder disease needed full-thickness segmental bladder resection. None of the 7 had a postoperative complication or recurrent bladder symptoms. Two had recurrent pelvic pain.
During follow-up, 20 of the 21 women with ureter disease (95%) reported pain relief. The one postoperative complication was a pleural effusion, fluid around the lung, managed by draining it.
One of the 21 women with ureter obstruction (4.8%) had silent loss of kidney function. Her kidney worked at only 10% to 20% on imaging after surgery.

Interpretation

This case series followed women with severe urinary tract endometriosis at one referral center. The authors saw more ureter cases here than in earlier reports. They think this may reflect how cases were defined, who was referred, and how doctors looked for the disease. In about two thirds of ureter cases, doctors did not suspect ureter disease before surgery. The findings support larger studies of surgery for bladder and ureter endometriosis.

RRM Context

Restorative reproductive medicine looks for the cause of pelvic pain. Deep endometriosis can harm a kidney with no warning signs. The authors advise checking the ureters in every woman having surgery for pelvic endometriosis. The woman with silent kidney loss had an earlier partial surgery, then hormonal suppressive therapy. The surgeons used both vaporization and excision.

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

Abstract

Objective

To evaluate the efficacy of the laparoscopic approach for the diagnosis and treatment of severe urinary tract endometriosis.

Design

Retrospective review of 28 cases of severe urinary tract endometriosis.

Setting

Center for Special Pelvic Surgery, a tertiary referral center.

Patients

Between October 1989 and September 1994, we treated 28 women who had deeply infiltrating urinary tract endometriosis (bladder, 7, ureter, 21).

Interventions

All procedures were performed laparoscopically.

Main Outcome Measures

Postoperative urinary function, pain relief, and complications.

Results

Those who had vesical endometriosis underwent partial cystectomy and primary repair. Partial ureteral obstruction was found in 17 women; 10 underwent ureterolysis and excision of endometriosis, and 7 had partial wall resection. Four patients with ureter involvement had complete obstruction. Three underwent partial resection and ureteroureterostomy, and one had ureteroneocystostomy. The rate of ureteral endometriosis in the present series is higher than that reported previously.

Conclusions

Severe infiltrative endometriosis of the bladder and the ureter can present without specific symptoms and can cause silent compromise of renal function. We demonstrated that the laparoscopic approach is safe and effective in the diagnosis and treatment of this entity.

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

Surgical Treatment Excision Surgery

Endometriosis › Surgical Treatment › Excision Surgery

Camran Nezhat, Farr Nezhat, Ceana H. Nezhat, Fariba Nasserbakht, Maurizio Rosati, Daniel S. Seidman

C Nezhat, F Nezhat, F Nasserbakht, M Rosati, Dan Seidman, Danny Seidman, D Seidman

PMID 8941055 8941055 DOI 10.1016/s0015-0282(16)58683-x 10.1016/s0015-0282(16)58683-x Nezhat et al. 1996, Nezhat 1996

Keywords

Adult, Endometriosis/pathology/surgery, Female, Humans, Laparoscopy, Middle Aged, Retrospective Studies, Treatment Outcome, Ureteral Diseases/pathology/surgery, Urinary Bladder Diseases/pathology/surgery

Urinary tract endometriosis treated by laparoscopy

Laparoscopic surgery treated severe bladder and ureter endometriosis

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

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Keywords