Center for Special Minimally Invasive and Robotic Surgery, 900 Welch Road, Suite 403, Palo Alto, CA, USA.
Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
Nat Rev Urol. 2017 Jun;14(6):359-372. doi: 10.1038/nrurol.2017.58. Epub 2017 May 3.
Endometriosis predominantly affects the pelvic reproductive organs but can also affect the urinary tract. A number of theories for the pathogenesis of endometriosis have been suggested, but the exact mechanisms remain elusive. Endometriotic lesions can be found on both the ureter and bladder, and the optimal therapeutic approach depends on the extent, depth, and location of these lesions. Medical approaches, including hormonal therapies such as GnRH agonists and oral contraceptives, tend to be a temporary measure, but can be useful in a preoperative setting or if the patient is unsuitable for surgery, and are also useful as a postoperative treatment. If surgical resection is deemed appropriate, laparoscopic management with or without robotic assistance of urological endometriosis is feasible and advisable. Newer techniques, such as nerve-sparing surgery, might help to decrease the risk of urinary complications following resection of deeply infiltrating endometriosis.
子宫内膜异位症主要影响盆腔生殖器官，但也可能影响泌尿系统。已经提出了许多关于子宫内膜异位症发病机制的理论，但确切的机制仍不清楚。在输尿管和膀胱上都可以发现子宫内膜异位病灶，最佳治疗方法取决于这些病灶的范围、深度和位置。包括 GnRH 激动剂和口服避孕药在内的激素疗法等医疗方法往往是一种临时措施，但在术前或患者不适合手术时很有用，也可作为术后治疗。如果认为手术切除是合适的，那么可以考虑使用腹腔镜管理联合或不联合机器人辅助进行泌尿系统子宫内膜异位症的治疗。一些新技术，如神经保护手术，可能有助于降低深部浸润性子宫内膜异位症切除术后发生尿并发症的风险。
