Outcome of laparoscopic ureterolysis for ureteral endometriosis.

OBJECTIVE

To evaluate the adequacy of laparoscopic ureterolysis as a primary treatment option for ureteral endometriosis.

DESIGN

Prospective collaborative cohort study.

SETTING

Gynecologic departments of three university hospitals.

PATIENT(S): Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography.

INTERVENTION(S): Laparoscopic ureterolysis.

MAIN OUTCOME MEASURE(S): Cure rate, disesase recurrence.

RESULT(S): Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral ligaments endometriosis in 65.5% (22/34) of cases. No inadvertent ureteral injuries occurred during ureterolysis. A partial wall resection of the ureter was necessary in one case and a segmental ureteral resection with vescicopsoas hitch was required in a women with intrinsic ureteral endometriosis. The median (range) follow-up time was 16 months (range: 3-53 months). Thirty-two patients (96.7%) had a patent ureter on the 3-month postoperative intravenous pyelography. The recurrence rate of ureteral lesions was 12.1% (4/33).

CONCLUSION(S): Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis.