Nezhat, C., Nezhat, F., Nezhat, C. H., Nasserbakht, F., Rosati, M., & Seidman, D. S. (1996). Urinary tract endometriosis treated by laparoscopy. Fertility and Sterility, 66(6), 920-924. https://doi.org/10.1016/s0015-0282(16)58683-x
Nezhat C, Nezhat F, Nezhat CH, Nasserbakht F, Rosati M, Seidman DS. Urinary tract endometriosis treated by laparoscopy. Fertil Steril. 1996;66(6):920-924. doi:10.1016/s0015-0282(16)58683-x
Nezhat, C., et al. "Urinary tract endometriosis treated by laparoscopy." Fertility and sterility, vol. 66, no. 6, 1996, pp. 920-924.
For EndNote, Zotero or Mendeley:
License
No open license is recorded for this paper. Reuse terms are set by the publisher.
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
The authors reviewed records of women treated at one tertiary referral center. The design is a retrospective case series. The series has no comparison group, and follow-up averaged 22 months. Women reported their own pain relief. The authors suggest the high share of ureter cases, compared with earlier reports, may relate to case definitions, a referral population and diagnostic approach. In about two thirds of ureter cases, ureter disease was unsuspected before surgery.
RRM Context
Restorative reproductive medicine looks for the cause of pelvic pain, and deep endometriosis can damage a kidney silently. The authors advise checking the ureters in every woman having surgery for pelvic endometriosis. The woman with silent kidney loss had earlier partial surgery, then hormonal suppressive therapy. The surgeons used both vaporization and excision. The paper reports outcomes for the group as a whole.
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.
Nezhat C et al., 2024·J Clin Med·Free full text on PubMed Central
Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.
Rahmioglu N et al., 2023·Nat Genet·Free full text on PubMed Central
Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention.
Nezhat C et al., 2019·JSLS : Journal of the Society of Laparoendoscopic Surgeons·Free full text on PubMed Central
Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%-10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES). Computerized searches of MEDLINE and PubMed were conducted using the key words "thoracic endometriosis," "catamenial pneumothorax," "catamenial hemothorax," and "catamenial hemoptysis." References from identified sources were manually searched to allow for a thorough review. TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence.
Dun EC et al., 2015·JSLS : Journal of the Society of Laparoendoscopic Surgeons·Free full text on PubMed Central
Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes. We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery. The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain. Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.
Leonardi M et al., 2020·Diagnostics (Basel, Switzerland)·Free full text on PubMed Central
We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.
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.
A patient developed hypertension from unilateral hydronephrosis produced by endometriosis. Her blood pressure fell promptly after decompression of the involved kidney.
Nackley AC et al., 2000·J Am Assoc Gynecol Laparosc
Ten women had endometriosis and pelvic peritoneal defects of the posterior leaf of the broad ligament, with the consistent finding of medial displacement of the ureter toward the uterosacral ligament. Ureterolysis at the time of surgery revealed the underlying course of the ureter and its proximity to the uterosacral ligament, making it susceptible to surgical injury. It is important for surgeons to be aware of this anatomic alteration associated with these specific peritoneal defects.
Endometriosis › Surgical Treatment › Excision Surgery
Camran Nezhat
C Nezhat
PMID 8941055 8941055 DOI 10.1016/s0015-0282(16)58683-x 10.1016/s0015-0282(16)58683-x Nezhat et al. 1996, Nezhat 1996
Cite this article
Nezhat, C., Nezhat, F., Nezhat, C. H., Nasserbakht, F., Rosati, M., & Seidman, D. S. (1996). Urinary tract endometriosis treated by laparoscopy. Fertility and Sterility, 66(6), 920-924. https://doi.org/10.1016/s0015-0282(16)58683-x
Nezhat C, Nezhat F, Nezhat CH, Nasserbakht F, Rosati M, Seidman DS. Urinary tract endometriosis treated by laparoscopy. Fertil Steril. 1996;66(6):920-924. doi:10.1016/s0015-0282(16)58683-x
Nezhat, C., et al. "Urinary tract endometriosis treated by laparoscopy." Fertility and sterility, vol. 66, no. 6, 1996, pp. 920-924.
