Surgery risky for women with ureteral endometriosis symptoms

For women with deep infiltrating endometriosis affecting the ureters, ureterovesical reimplantation surgery may provide some help. A small French study published in Journal of Gynecology Obstetrics and Human Reproduction looked at the long-term surgical outcomes as well as clinical and radiological symptoms.

Researchers retrospectively looked at women with endometriosis who underwent ureterovesical reimplantation at Lille hospital from 2003 at 2013. A total of 17 patients were included with 29% having a history of urologic surgery and 53% had urological symptoms of endometriosis. The average delay between the diagnosis of endometriosis and the ureteral reimplantation surgery was 64 ±65 months.

Urinary functional symptoms, mainly presenting as lower back pain, were seen in 47% of patients. In 82% of the cases, the ureteral lesion was known preoperatively and linked with hydroureteronephrosis. Renal function was impaired in 23% of the cases and 35% of the women had renal atrophy. Patients were followed-up for 45 ±27 months. Following the surgery, 41% of patients had at least 1 immediate nerve compression, postoperative complication-fistula, or postoperative infection. Dyspareunia, urinary functional symptoms, and dysmenorrhea were found in 47% of the women.

The researchers stressed that ureterovesical implantation is a major surgery and women with endometriosis frequently develop complications from it. Reducing risks requires close collaboration among urologists, radiologists, and gynecologists. When preparing for the procedure, a comprehensive collection of patient information is a necessity.

Chudzinski A, Collinet P, Flamand V, Rubod C. Ureterovesical reimplantation for ureteral deep infiltrating endometriosis: A retrospective study.  Gynecol Obstet Hum Reprod. 2017;46(3):229-233.