Laparoscopic surgery for severe ureteric endometriosis

Abstract

Objectives: To describe the outcomes of laparoscopic surgery for severe ureteric endometriosis.

Study design: Retrospective descriptive study of the clinical and surgical outcomes for patients who underwent laparoscopic surgery for severe ureterohydronephrosis due to endometriosis. The surgery consisted of laparoscopic ureterolysis, ureteric end-to-end anastomosis and ureteral stenting at the Department of Obstetrics and Gynecology, Strasbourg Hospitals, between June 2004 and June 2009. Data were collected from patients' notes and also included telephone interview. Normally distributed data are presented as mean ± SD, and skewed data as median (range). Categoric variables are reported as absolute values and percentages. Continuous variables are compared using the paired samples t-test. Statistical significance was set at P<0.05.

Results: Thirteen patients had severe disease. Two patients had non-functioning kidneys. Left sided lesions were more common (76.9%). All patients had associated deep infiltrative endometriosis (DIE) elsewhere in the pelvis. Laparoscopic treatment was feasible in all cases without the need to convert. Ureterolysis was performed in seven patients (53.8%) and segmental resection with end-to-end anastomosis in six (46.2%) patients. Ureteric wall endometriotic infiltration was present in four cases (30.8%). Median follow up duration was 24 months. All patients had improvement of their pain symptoms. There were no intraoperative complications. Major postoperative complications were seen in three patients (23%).

Conclusions: Ureteric involvement is usually asymptomatic, and therefore in patients with evidence of deep endometriosis it must be excluded by ultrasound or magnetic resonance imaging. Laparoscopic treatment of ureteric endometriosis is feasible. Intrinsic ureteric endometriosis is quite frequent in severe ureterohydronephrosis. Complete excision of the disease is essential to improve pain symptomatology and to prevent recurrence of disease. Long term follow up is required to exclude any stenosis.