Department of Urology, Columbia University Medical Center, NY, USA.
Urology. 2013 Aug;82(2):307-12. doi: 10.1016/j.urology.2013.04.012. Epub 2013 Jun 13.
To present the largest experience on the ureteroscopic management of ureteral obstruction secondary to intraluminal endometrial implantation.
We retrospectively evaluated patients who underwent ureteroscopic management of intraluminal endometriosis from 1996 to 2012. All patients were diagnosed with ureteroscopic biopsy and underwent at least 1 ureteroscopic ablation with a holmium YAG (Ho:Yag) laser. Patients were monitored for evidence of disease persistence, recurrence, or progression with computed tomography, sonography, renal scan, ureteroscopy, and retrograde urography. Success was defined as the complete eradication of ureteral endometriosis, resolution of symptoms, and maintenance of renal function.
Five patients were identified. Mean age was 37.5 years. All patients had hydroureteronephrosis at presentation whereas 2 had severely impaired renal function. Three patients were successfully treated with a single ablative procedure, whereas 2 had persistent symptomatic hydroureteronephrosis and underwent repeat ablation. Of those requiring repeat ablation, 1 became disease-free after the second ablation, whereas the other had persistence of disease, requiring nephroureterectomy. Three patients developed ureteral strictures, requiring balloon dilation and serial stent exchanges. At a median follow-up of 35 months (16-84), overall success rate was observed in 4 of 5 patients (80%).
Endometriosis affects approximately 15% of premenopausal women and can present anywhere along the urinary tract including the ureters, which might result in urinary obstruction and impaired renal function. Although surgical resection is the conventional treatment option for intraluminal endometriosis, ureteroscopic management is a viable nephron-sparing alternative. Follow-up imaging, including ureteroscopic surveillance and retrograde urography is recommended to detect disease recurrence or progression, or both.
介绍腔内子宫内膜植入导致输尿管梗阻的输尿管镜处理经验。
我们回顾性评估了 1996 年至 2012 年间接受腔内子宫内膜异位症输尿管镜处理的患者。所有患者均经输尿管镜活检诊断，并至少进行了 1 次钬激光输尿管镜消融治疗。通过计算机断层扫描、超声、肾扫描、输尿管镜检查和逆行尿路造影监测疾病持续存在、复发或进展的证据。成功定义为输尿管子宫内膜异位症完全消除、症状缓解和肾功能维持。
共确定了 5 名患者。平均年龄为 37.5 岁。所有患者就诊时均存在肾盂积水，而 2 例患者肾功能严重受损。3 例患者通过单次消融治疗成功治疗，而 2 例患者持续存在症状性肾盂积水并进行重复消融治疗。在需要重复消融的患者中，1 例在第二次消融后疾病痊愈，而另 1 例疾病持续存在，需要肾输尿管切除术。3 例患者发生输尿管狭窄，需要球囊扩张和连续支架交换。在中位随访 35 个月（16-84 个月）时，5 例患者中有 4 例（80%）总体成功率。
子宫内膜异位症影响约 15%的绝经前妇女，可发生在泌尿道的任何部位，包括输尿管，可能导致尿路梗阻和肾功能受损。虽然手术切除是腔内子宫内膜异位症的传统治疗选择，但输尿管镜治疗是一种可行的保肾替代方法。建议进行随访影像学检查，包括输尿管镜检查和逆行尿路造影，以检测疾病复发或进展，或两者兼而有之。
