Division of Nephrology IRCCS Humanitas, University of Milan, Ospedale San Paolo, Milan, Italy. claudio.ponticelli @ fastwebnet.it
Nephron Clin Pract. 2010;114(2):c89-93. doi: 10.1159/000254380. Epub 2009 Nov 3.
Little attention has been paid by the renal literature to ureteral endometriosis, a rare and silent disorder that can eventually lead to renal failure. In endometriosis, the ureteral involvement can be limited to a single ureter, more often the left one, or both ureters with consequent urine tract obstruction and ureterohydronephrosis. In most cases, the ureteral obstruction is caused by endometrial tissue surrounding the ureter (extrinsic ureteral endometriosis). In the remaining cases, endometrial cells are located within the ureter (intrinsic ureteral endometriosis). Progressive ureteral obstruction can be insidious in onset and can ultimately lead to renal failure if a correct diagnosis is missed. The true incidence of renal failure caused by endometriosis is completely unknown, although cases have been reported in the literature. The diagnosis of ureteral endometriosis is difficult since the disease may be clinically silent or associated with non-specific symptoms. Only a high index of suspicion and radiological support may help to obtain an early diagnosis. However, while renal imaging is useful in the cases of extrinsic endometriosis, the diagnosis of intrinsic endometriosis often requires ureteroscopy or laparoscopy. The prognosis of ureteral endometriosis depends on the time of diagnosis. In too many cases of bilateral obstruction, the patient is referred to the nephrologist because of an advanced, irreversible renal failure. Although some patients may benefit from progestin or anti-arotamase therapy, in most cases of ureteral endometriosis surgery is needed, laparoscopy surgery being preferred today to laparatomy.
肾脏文献很少关注输尿管子宫内膜异位症，这是一种罕见且无声的疾病，最终可导致肾衰竭。在子宫内膜异位症中，输尿管受累可能局限于单侧输尿管，更常见于左侧输尿管，也可能累及双侧输尿管，导致尿路梗阻和输尿管积水。在大多数情况下，输尿管梗阻是由围绕输尿管的子宫内膜组织引起的（外生性输尿管子宫内膜异位症）。在其余情况下，子宫内膜细胞位于输尿管内（内生性输尿管子宫内膜异位症）。输尿管渐进性梗阻的发病可能隐匿，如果未能正确诊断，最终可导致肾衰竭。由于文献中已有报道，因此完全不清楚由子宫内膜异位症引起的肾衰竭的真实发病率。输尿管子宫内膜异位症的诊断困难，因为该病可能无临床症状或伴有非特异性症状。只有高度怀疑和影像学支持才能有助于早期诊断。然而，虽然肾脏影像学检查在外生性子宫内膜异位症的情况下有用，但内生性子宫内膜异位症的诊断通常需要输尿管镜或腹腔镜检查。输尿管子宫内膜异位症的预后取决于诊断时间。在许多双侧梗阻的情况下，由于进展性、不可逆转的肾衰竭，患者被转介给肾病医生。尽管一些患者可能受益于孕激素或抗芳香化酶治疗，但在大多数输尿管子宫内膜异位症病例中需要手术治疗，目前更倾向于采用腹腔镜手术而不是剖腹手术。
