Journal of Minimally Invasive Gynecology

Urinary tract involvement in endometriosis includes presence of endometriosis deposits inside or across the bladder, ureters, urethra, or kidney. Urethral lesions may cause important morbidity as silent lack of renal feature is commonplace in these sufferers. Signs associated with pelvic endometriosis and/or of urinary involvement perhaps regularly nonspecific. The maximum common findings encompass menstrual symptoms, flank ache, gross hematuria, and pelvic mass.

Ureteric obstruction resulting in hydronephrosis is a rare manifestation of ureteric endometriosis. It occurs as a result of intrinsic involvement inside the ureteric, or from extrinsic compression of the ureteric through a pelvic endometrioma. In instances of intrinsic involvement, ectopic endometrial tissue is present in the muscular is propria, lamina propriety or ureteric lumen. In extrinsic instances endometriosis occurs inside the ureteric adventitia and adjacent soft tissues most effective. Extrinsic involvement is about 4 instances greater commonplace than intrinsic disorder.

Deeply infiltrating endometriosis (die) most normally invades the rectovaginal space, uterosacral ligaments, bowel or urinary tract. Our case changed into a die because of the bilateral ureteric involvement.

Diagnosis of ureteric endometriosis is elusive and relies heavily on medical suspicion. In our case, patient complained of hesitancy of maturation usually at some point of menses that's a as an alternative uncommon presentation of ureteric endometriosis. This symptom might be defined by means of growth of active endometriosis tissue across the ureters. On account that ureteric endometriosis takes place commonly with pelvic endometriosis there may be a need for multidisciplinary management. Progressive ureteric obstruction may be insidious and bilateral compromise of ureters can also in the end result in renal failure. 30% of patients will have decreased kidney function at the time of prognosis that could result in silent kidney loss.

Clinical and surgical remedy is available for ureteric endometriosis. Elements influencing treatment choice consist of patients' age, interest in maintaining fertility, severity of signs and presence or absence of ureteric obstruction and its effects. Scientific therapy can be presented to those wanting to maintain reproductive capability or those with regular renal function and no enormous obstruction. In our case surgical control was decided in order that the young lady is relieved of the obstruction and stops destiny renal damage. More conservative ureterolysis changed into executed minimizing morbidity related to surgical procedure. To reduce the threat of ureteric fibrosis a double j stent was located for 6 weeks. A check ivp after removal of ureteric stents confirmed resolution of the obstruction. At 6 months observe up, the patient is relieved of her signs and usg kub shows ordinary pelvic clypeal machine. She has been advised and counseled to comply with up regularly keeping a vigilant eye on recurrence.

Gynaecologylaproscopy- expert, prognosis of ureteral endometriosis