Abstract
The optimal management of ureteral endometriosis (UE) is not yet well defined. The
choice on surgical approach and type of procedure has been based both on surgeons’
experience and the location and depth of the lesion. The aim of this study was to
review evidence about laparoscopic management of ureteral endometriosis, including
preoperative evaluation, surgical details and postoperative follow-up. PubMed Central
and SCOPUS databases were searched to identify studies reporting cases of laparoscopically
managed ureteral endometriosis and including data regarding preoperative findings,
surgical interventions and postoperative follow-up. Two sets of MeSH terms were used:
1) “laparoscopy”, “endometriosis” and “ureter”; 2) “laparoscopy”, “endometriosis”
and “urinary tract”. Databases were searched for articles published since 1996, in
English, French, Spanish and Portuguese, without restrictions regarding study design.
Studies reporting surgical approaches other than conventional laparoscopy were excluded,
as were case reports and case studies including fewer than 5 cases. From 327 studies
obtained through database searching, 18 articles were finally included in this review,
including a total of 700 patients with ureteral endometriosis. 57% of patients had
at least one previous surgery for endometriosis. Preoperative evidence of significant
hydroureter/hydronephrosis was found in 324 of 671 (48.3%) patients. Dysmenorrhea
(81.4%), pelvic pain (70.2%) and dyspareunia (66.4%) were the presenting symptoms
more commonly reported by the patients. Most patients presented no symptoms specific
to the urinary tract. Ureteral endometriosis was more frequent in the left ureter
(53.6%) and it was bilateral in 10.6% of cases. Ureterolysis alone was considered
a sufficient procedure in 579 of 668 patients (86.7%), and in the remaining 89 patients
ureteral resection was necessary. Rectovaginal and uterosacral involvement was present
in 58.8% and 47.9% of patients, respectively. Concomitant ureteral and bladder endometriosis
was described in 19.8% of patients. Only 6 studies reported cases of accidental ureteral
injuries, in 1–24% of patients. Cases of conversion to laparotomy are reported in
only 6 studies, in 3–6,7% of patients. Major postoperative complications occurred
in 21 out of 682 patients (3.2%). The need for reoperation during follow-up period
because of ureteral endometriosis persistence or recurrence was 3.9%. When performed
in specialized centers, laparoscopic ureterolysis showed to be a feasible and safe
procedure, with a low risk of complications and with satisfactory long-term results.
This conservative approach may be used as the initial treatment option in most patients
with ureteral endometriosis.
Keywords
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Article info
Publication history
Published online: December 12, 2016
Accepted:
December 10,
2016
Received in revised form:
December 4,
2016
Received:
September 24,
2016
Identification
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© 2016 Elsevier Ireland Ltd. All rights reserved.
