2
|
Yang K, Cheng S, Cai Y, Qiao J, Xu Y, Li X, Xiong S, Lu Y, Mei A, Li X, Zhou L. Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases. BMC WOMENS HEALTH 2021; 21:206. [PMID: 34001081 PMCID: PMC8130255 DOI: 10.1186/s12905-021-01349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/09/2021] [Indexed: 11/17/2022]
Abstract
Background To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. Methods To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. Results Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. Conclusions Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.
Collapse
Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yukun Cai
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Jiankun Qiao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Ye Lu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Aobing Mei
- Department of Urology, The Second People's Hospital of Guiyang, Guizhou, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| |
Collapse
|
3
|
Zahid M, Nepal P, Nagar A, Batchala PP, Kumar D, Ojili V. Imaging of ureter: a primer for the emergency radiologist. Emerg Radiol 2021; 28:815-837. [PMID: 33851303 DOI: 10.1007/s10140-021-01930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.
Collapse
Affiliation(s)
- Mohd Zahid
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Devendra Kumar
- Department of Clinical Imaging, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA.
| |
Collapse
|
5
|
Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, Ferrero S. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2019; 24:710-730. [PMID: 30165449 DOI: 10.1093/humupd/dmy027] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The ureter is the second most common site affected by urinary tract endometriosis, after the bladder. Optimal strategies in the diagnosis and treatment of ureteral endometriosis (UE) are not yet well defined. OBJECTIVE AND RATIONALE The aim of this study was to systematically review evidence regarding the epidemiology, pathophysiology, diagnosis, medical and surgical treatment, impact on fertility and risk of malignant transformation of UE. SEARCH METHODS A systematic literature review, by searching the MEDLINE and PUBMED database until April 2018, was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/PROSPERO CRD42017060065). A total of 67 articles were selected to be included in this review. OUTCOMES The involvement of the ureter by endometriosis is often asymptomatic or leads to non-specific symptoms. When the diagnosis is delayed, UE may lead to persistent hydronephrosis and eventually loss of renal function. Ultrasonography is the first-line technique for the assessment of UE; alternatively, magnetic resonance imaging provides an evaluation of ureteral type involvement. The surgical treatment of UE aims to relieve ureteral obstruction and avoid disease recurrence. It includes conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneocystostomy performed in relation to the type of ureteral involvement. Fertility and pregnancy outcomes are in line with those observed after surgical treatment of deep infiltrating endometriosis (DIE). Current evidence does not support the potential risk of malignant transformation of UE. WIDER IMPLICATIONS In this article, we review available evidence on ureteral endometriosis, providing a useful tool to guide physicians in the management of this disease. Diagnosis and management of UE remain a challenge. In relation to the degree of ureteral involvement and the association with other DIE implants, the surgical approach should be planned and carried out in an interdisciplinary collaboration between gynecologist and urologist.
Collapse
Affiliation(s)
- Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Carolina Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| | - Ennio Biscaldi
- Department of Radiology, Galliera Hospital, Genova, Italy
| | - Valerio Gaetano Vellone
- Department of Surgical and Diagnostic Sciences, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, 'Sacro Cuore - Don Calabria' Hospital, Negrar, Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.,Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|