Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy
Minimally Invasive Gynecological Surgery Unit, S.Orsola Hospital, University of Bologna, Bologna, Italy.
Hum Reprod. 2015 Apr;30(4):833-9. doi: 10.1093/humrep/deu360. Epub 2015 Jan 12.
In women with deeply infiltrating endometriosis (DIE) what is the prevalence of involvement of endometriotic tissue and fibrosis in ureteral endometriosis (UE), as assessed by histological staining?
In women with DIE, ureteral involvement is more often due to endometriotic tissue rather than fibrosis.
In the current literature, histological evaluation of ureteral endometriosis is mainly based on the degree of wall infiltration by endometriosis instead of the tissue composition. A few studies reported ill-defined and contradictory histological data on the tissue composition of UE.
STUDY DESIGN, SIZE, DURATION: Retrospective observational study based on clinical records of women affected by DIE, laparoscopically treated for UE at a tertiary referral center, between January 2010 and March 2013. All cases of ureteral nodule excision or ureterectomy with histological examination of the specimens were included. Exclusion criteria were other identified causes of hydroureteronephrosis, medical therapy for a period of at least 3 months before surgery and previous surgery for DIE.
PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 77 patients were included in the study and among them seven (9%) presented with bilateral ureteral involvement, giving a total of 84 cases of UE available for analysis. All patients had stage IV endometriosis. According, respectively, to the presence of endometrial glands and/or stroma cells or of fibrotic tissue only, the endometriotic UE and fibrotic UE groups were compared with regard to hydroureteronephrosis at pre-operative urinary tract computerized tomography scan, type of surgical procedure performed to treat UE (nodule removal or ureterectomy), association with other locations of the disease and post-operative complications (ureteral fistula or stenosis).
For the 84 cases of UE, 65 (77%) and 19 (23%), respectively, showed endometriotic tissue and fibrotic tissue only. Presence of hydroureteronephrosis and endometriotic pattern of UE showed a significant association [endometriotic UE 44/65 (68%) versus fibrotic UE 8/19 (42%); P = 0.04]. Fibrotic pattern of UE and presence of concomitant recto-vaginal endometriosis showed a significant association [endometriotic group: 29/65 (45%) versus fibrotic group 18/19 (95%); P < 0.001].
LIMITATIONS, REASONS FOR CAUTION: The retrospective and monocentric (tertiary referral center) study design.
Besides the distinction between extrinsic and intrinsic UE based on the degree of wall infiltration by endometriosis, a new classification according to the histological pattern of UE could be useful for clinicians, both in the diagnostic and therapeutic fields.
STUDY FUNDING/COMPETING INTERESTS: None.
在患有深部浸润性子宫内膜异位症（DIE）的女性中，通过组织学染色评估输尿管子宫内膜异位症（UE）中子宫内膜异位组织和纤维化的受累情况，其患病率如何？
在患有 DIE 的女性中，输尿管受累更常是由于子宫内膜异位组织而不是纤维化。
在当前文献中，UE 的组织学评估主要基于子宫内膜异位症对壁的浸润程度，而不是组织成分。少数研究报告了 UE 组织成分的不明确和矛盾的组织学数据。
研究设计、大小和持续时间：这是一项基于 2010 年 1 月至 2013 年 3 月在三级转诊中心接受腹腔镜治疗 UE 的患有 DIE 的女性临床记录的回顾性观察性研究。纳入所有输尿管结节切除或输尿管切除术的病例，对标本进行组织学检查。排除标准为其他已确定的肾积水原因、术前至少 3 个月的药物治疗和 DIE 术前手术。
参与者/材料、地点、方法：共有 77 名患者纳入研究，其中 7 名（9%）患有双侧输尿管受累，共有 84 例 UE 可用于分析。所有患者均患有 IV 期子宫内膜异位症。根据存在子宫内膜腺体和/或基质细胞或仅存在纤维组织，比较了具有子宫内膜异位组织的 UE 和纤维性 UE 组，比较了术前尿路计算机断层扫描检查的肾积水情况、治疗 UE 采用的手术类型（结节切除或输尿管切除术）、与其他部位疾病的相关性以及术后并发症（输尿管瘘或狭窄）。
对于 84 例 UE，分别有 65 例（77%）和 19 例（23%）分别显示出子宫内膜异位组织和仅纤维组织。存在肾积水和 UE 的子宫内膜异位模式有显著关联[子宫内膜异位组：44/65（68%）与纤维性组：8/19（42%）；P=0.04]。纤维性 UE 模式和同时存在直肠阴道子宫内膜异位症有显著关联[子宫内膜异位组：29/65（45%）与纤维性组：18/19（95%）；P<0.001]。
局限性、谨慎的原因：回顾性和单中心（三级转诊中心）研究设计。
除了基于子宫内膜异位症对壁的浸润程度区分外在性和内在性 UE 之外，根据 UE 的组织学模式进行的新分类对于临床医生在诊断和治疗领域都可能是有用的。
研究资金/利益冲突：无。
