Ureter endometriosis is a type of urinary tract endometriosis that involves the ureters. Ureters are the tubes that connect the kidneys to the bladder. When endometrial-like tissue is found on these tubes, we call it ureteral endometriosis. This usually occurs in association with deep infiltrating endometriosis and isolated disease is very rare.
Involvement of the ureters is relatively rare, comprising 9-23% of all urinary tract endometriosis which themselves are found in only 1-5% of patients with endometriosis.
Most commonly, ureteral endometriosis involves only one ureter with a predominance of the left one but bilateral disease can also occur. Endometriotic lesions may occur anywhere along the ureter and this can lead to different signs, symptoms and complications.
What you may experience if you suffer from ureteral endometriosis:
- 50% of patients remain asymptomatic
- Pelvic pain
- Recurrent urinary tract infections
- Pain during urination
- Renal colic or flank pain
- Blood in urine
The endometriosis nodules may lead to obstruction of the ureter causing backflow of urine into the kidney which results in enlargement of the kidney and possible renal failure.
How will your doctor diagnose ureteral endometriosis?
Your gynecologist will begin with a pelvic exam and an ultrasound.
Further imaging with MRI or CT might be indicated.
Your doctor may also get specific kidney imaging to assess kidney function and size.
Finally, a ureteroscopy would aid in diagnosis as it allows visualization of the nodules and performance of a biopsy for definite diagnosis.
Management:
Treatment of ureter endometriosis is mainly surgical.
Surgical treatment aims to relief ureteral obstruction and avoid recurrence. There is no clearly defined surgical approach and the type of procedure depends on the extent of disease and kidney function. The surgery removes the endometrial-like lesions along with the part of the ureter and possibly reconnect the ureter to the bladder ( ureteral reimplantation) or the ureter to its distal healthy part after removing the damaged portion ( uretero-ureteral anastomosis).
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. Ureteral surgery is technically challenging and requires sometimes a multidisciplinary approach with a urologist.
Choose your surgeon with the training and the experience to manage these complex conditions.
Dr. Moawad is a highly reputable leading expert in this domain.
