Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France.
Urology. 2011 Dec;78(6):1269-74. doi: 10.1016/j.urology.2011.07.1403. Epub 2011 Sep 29.
To report on the prevalence, surgical management, and outcome of urinary tract endometriosis (UTE) in a cohort of 221 patients undergoing laparoscopic surgery for severe endometriosis. UTE can cause significant morbidity, such as silent kidney or progressive renal function loss. Its frequency is underestimated and data on laparoscopic management are scarce.
Between 2007 and 2010, 43 patients were eligible for this single-center, retrospective study. The inclusion criterion was the presence of UTE (ie, bladder and/or ureteral endometriosis). All patients were operated laparoscopically.
The prevalence of UTE was 19.5% (43/221). There was no correlation between bladder and ureteral endometriosis (P >.05). Ureteral endometriosis was associated with patient's age (P <.01). Patients with bladder, but not ureteral, involvement complained more frequently about dysuria, hematuria, and urinary tract infections. Intraoperative and magnetic resonance imaging (MRI) findings revealed a moderate to good correlation. UTE was not associated with rectovaginal or bowel endometriosis, but rather with involvement of the uterosacral ligaments (P <.01). Twenty-two patients with bladder endometriosis were treated by mucosal skinning and 11 patients underwent partial cystectomy. Superficial ureteral excision was performed in 4 patients, whereas resection with ureteroureterostomy was done in 9 patients. There was no difference regarding the intra- and postoperative complications in patients with or without UTE.
In severe pelvic endometriosis, involvement of the urinary tract is quite common. Laparoscopic management is feasible and safe. Because of the lack of specific symptoms, the preoperative diagnosis of ureteral endometriosis still remains a challenge. Pelvic MRI represents a useful preoperative diagnostic tool.
报告在 221 例因严重子宫内膜异位症接受腹腔镜手术的患者中，尿路子宫内膜异位症（UTE）的患病率、手术治疗和结局。UTE 可引起严重的发病率，如肾脏功能丧失或进行性肾脏功能丧失。但其发病率被低估，且腹腔镜管理数据有限。
在 2007 年至 2010 年期间，43 例患者符合本单中心回顾性研究的入选标准。纳入标准为存在 UTE（即膀胱和/或输尿管子宫内膜异位症）。所有患者均接受腹腔镜手术。
UTE 的患病率为 19.5%（43/221）。膀胱和输尿管子宫内膜异位症之间无相关性（P>.05）。输尿管子宫内膜异位症与患者年龄相关（P<.01）。有膀胱受累但无输尿管受累的患者更频繁地抱怨尿痛、血尿和尿路感染。术中发现与磁共振成像（MRI）结果具有中度至良好的相关性。UTE 与直肠阴道或肠子宫内膜异位症无关，但与子宫骶韧带受累相关（P<.01）。22 例膀胱子宫内膜异位症患者采用黏膜剥皮治疗，11 例患者行部分膀胱切除术。4 例患者行输尿管浅表切除，9 例患者行输尿管端端吻合术。有或无 UTE 的患者的围手术期并发症无差异。
在严重的盆腔子宫内膜异位症中，尿路受累相当常见。腹腔镜管理是可行且安全的。由于缺乏特异性症状，输尿管子宫内膜异位症的术前诊断仍然具有挑战性。盆腔 MRI 是一种有用的术前诊断工具。
