Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy.
Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genova, Italy.
Hum Reprod Update. 2018 Nov 1;24(6):710-730. doi: 10.1093/humupd/dmy027.
The ureter is the second most common site affected by urinary tract endometriosis, after the bladder. Optimal strategies in the diagnosis and treatment of ureteral endometriosis (UE) are not yet well defined.
The aim of this study was to systematically review evidence regarding the epidemiology, pathophysiology, diagnosis, medical and surgical treatment, impact on fertility and risk of malignant transformation of UE.
A systematic literature review, by searching the MEDLINE and PUBMED database until April 2018, was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/PROSPERO CRD42017060065). A total of 67 articles were selected to be included in this review.
The involvement of the ureter by endometriosis is often asymptomatic or leads to non-specific symptoms. When the diagnosis is delayed, UE may lead to persistent hydronephrosis and eventually loss of renal function. Ultrasonography is the first-line technique for the assessment of UE; alternatively, magnetic resonance imaging provides an evaluation of ureteral type involvement. The surgical treatment of UE aims to relieve ureteral obstruction and avoid disease recurrence. It includes conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneocystostomy performed in relation to the type of ureteral involvement. Fertility and pregnancy outcomes are in line with those observed after surgical treatment of deep infiltrating endometriosis (DIE). Current evidence does not support the potential risk of malignant transformation of UE.
In this article, we review available evidence on ureteral endometriosis, providing a useful tool to guide physicians in the management of this disease. Diagnosis and management of UE remain a challenge. In relation to the degree of ureteral involvement and the association with other DIE implants, the surgical approach should be planned and carried out in an interdisciplinary collaboration between gynecologist and urologist.
输尿管是继膀胱之后第二常见的受尿路子宫内膜异位症影响的部位。输尿管子宫内膜异位症（UE）的诊断和治疗的最佳策略尚未得到很好的定义。
本研究的目的是系统地回顾有关 UE 的流行病学、病理生理学、诊断、药物和手术治疗、对生育能力的影响以及恶性转化风险的证据。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明，对 MEDLINE 和 PUBMED 数据库进行了系统文献检索，并于 2018 年 4 月前进行了检索，该研究已在 PROSPERO 注册（www.crd.york.ac.uk/PROSPERO CRD42017060065）。共选择了 67 篇文章纳入本综述。
输尿管受累的子宫内膜异位症常无症状或导致非特异性症状。当诊断延迟时，UE 可能导致持续的肾积水，并最终导致肾功能丧失。超声检查是评估 UE 的一线技术；或者，磁共振成像可评估输尿管受累类型。UE 的手术治疗旨在解除输尿管梗阻并避免疾病复发。它包括保守的输尿管松解术或根治性方法，例如输尿管切除术和端端吻合术或输尿管吻合术，具体取决于输尿管受累的类型。生育和妊娠结局与深部浸润性子宫内膜异位症（DIE）手术后观察到的结果一致。目前的证据不支持 UE 恶性转化的潜在风险。
在本文中，我们回顾了输尿管子宫内膜异位症的现有证据，为医生管理这种疾病提供了有用的工具。UE 的诊断和管理仍然是一个挑战。根据输尿管受累的程度以及与其他 DIE 植入物的关系，应在妇科医生和泌尿科医生之间进行跨学科协作来规划和进行手术治疗。
