Antonelli Alessandro, Simeone Claudio, Zani Danilo, Sacconi Tazio, Minini Gianfranco, Canossi Emma, Cunico Sergio Cosciani
Chair and Department of Urology, University of Brescia, Italy.
Eur Urol. 2006 Jun;49(6):1093-7; discussion 1097-8. doi: 10.1016/j.eururo.2006.03.037. Epub 2006 Apr 4.
To present and discuss clinical and surgical management of urologic endometriosis.
Retrospective review of a database on surgical patients with endometriosis.
Thirty-one patients (incidence, 2.6%; mean age, 33.1 yr) were affected by urologic endometriosis (bladder, 12; ureter, 15; both, 4). Bladder endometriosis was revealed by symptoms related to menses and showed a typical endoscopic picture, whereas ureteral involvement had a nonspecific or silent symptomatology. All patients affected by bladder endometriosis and undergoing transurethral resection (2 cases) developed a bladder recurrence; a ureteral recurrence was observed in two of six patients submitted to laparoscopic ureterolysis and in one of two patients submitted to ureterectomy with ureteroureterostomy. Conversely, no relapses were observed among the 14 patients who had partial cystectomy or the 9 who had ureterectomy and ureterocystoneostomy. Finally, two patients underwent nephrectomy due to end-stage renal atrophy.
Cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms; the upper urinary tract should be evaluated in all patients with pelvic endometriosis to exclude asymptomatic ureteral involvement. Partial cystectomy gives the best results when used to treat bladder endometriosis. Ureterolysis can be successful only in case of limited ureteral involvement with no urinary obstruction, whereas terminal ureterectomy and ureterocystoneostomy should be preferred in case of obstructive ureteral endometriosis.
介绍并讨论泌尿外科子宫内膜异位症的临床及手术治疗。
对子宫内膜异位症手术患者的数据库进行回顾性分析。
31例患者（发病率2.6%；平均年龄33.1岁）患有泌尿外科子宫内膜异位症（膀胱12例；输尿管15例；膀胱和输尿管均受累4例）。膀胱子宫内膜异位症通过与月经相关的症状得以发现，并呈现典型的内镜表现，而输尿管受累则表现为非特异性或无症状。所有接受经尿道切除术的膀胱子宫内膜异位症患者（2例）均出现膀胱复发；在6例接受腹腔镜输尿管松解术的患者中有2例以及2例接受输尿管切除并输尿管输尿管吻合术的患者中有1例出现输尿管复发。相反，在14例行部分膀胱切除术的患者或9例行输尿管切除并输尿管膀胱吻合术的患者中未观察到复发。最后，2例患者因终末期肾萎缩接受了肾切除术。
对于有下尿路症状的盆腔子宫内膜异位症女性，建议进行膀胱镜检查；所有盆腔子宫内膜异位症患者均应评估上尿路，以排除无症状的输尿管受累。部分膀胱切除术用于治疗膀胱子宫内膜异位症时效果最佳。仅在输尿管受累有限且无尿路梗阻的情况下，输尿管松解术可能成功，而对于梗阻性输尿管子宫内膜异位症，应首选输尿管末端切除术和输尿管膀胱吻合术。
