Ureteral endometriosis: an endoscopic diagnosis

Ureteral endometriosis: the role of magnetic resonance imaging

In six women out of 792 who underwent magnetic resonance imaging (MRI) for management of deep infiltrating endometriosis (DIE), ureteral involvement was suspected. Ureteral endometriosis was identified as a hypointense nodule on T2- weighted images and hyperintense foci on T1-weighted images. Magnetic resonance urography detected obstruction and hydronephrosis in half the women. Detection with MRI of periureteral involvement (extrinsic endometriosis) in four women rather than ureteral wall lesions (intrinsic endometriosis) in two women is an original finding from this series. Magnetic resonance imaging features were correlated and matched with intraoperative and pathologic findings. Magnetic resonance imaging is a useful preoperative tool for the diagnosis and assessment of ureteral endometriosis in rare cases when such lesions have been suspected.

Endometriosis of the urinary tract

Genitourinary endometriosis is a rare manifestation of a common disease. Ectopic endometrial tissue may extrinsically involve or intrinsically invade the bladder or ureter, and, less commonly, the urethra or kidney. Bladder involvement usually presents with irritative symptoms, whereas ureteral disease may present with asymptomatic renal failure. Therefore, a high index of suspicion is necessary, and genitourinary endometriosis should be considered in all symptomatic women with a history of cesarean delivery of other gynecologic surgery. In women beyond reproductive age, definitive surgical treatment is preferred, with removal of the ectopic tissue, relief of obstruction, and castration with or without hysterectomy. In those who desire future fertility, conservative surgery and/or hormonal therapy is often recommended.

Ureterorenoscopy: a new approach in the diagnosis and treatment of upper urinary tract disorders

Endoscopy is a well-established method of diagnosing and treating lower urinary tract disorders. Developments in the optical quality and manufacture of more precise instruments now also makes inspection of the upper urinary tract possible. Today, ureteric stones can easily be dealt with by non-operative measures with the use of operating ureterorenoscope. Diagnosis and treatment of other pathological conditions of the upper urinary tract are also possible. It is also the best way of assessing ureteric and renal pelvic tumours.