Alenezi Saad, Zaheer Mohammad, Khudair Salah
Urology Department, Jaber Alahmad Hospital, Kuwait.
Urology Department, Al Jahra Hospital, Kuwait.
Int J Surg Case Rep. 2023 Mar;104:107966. doi: 10.1016/j.ijscr.2023.107966. Epub 2023 Mar 4.
Ureteral endometriosis is a rare disease and it has variable and subtle clinical presentation and often it lead to delayed diagnosis and worse outcome.
Here we present a 44-year-old married lady who presented with dull aching right iliac fossa pain. CT urography right moderate hydro-uretero nephrosis with a suspicion of a mass in the lower right ureter. Diagnostic rigid ureteroscopy showed completely intraluminal polypoidal pedunculated right lower ureteral mass with near total occlusion of the lumen, which was excised completely by Ho: Yag laser. Histopathology confirmed pure endometriosis tissue with no ureteral tissue. Follow up showed no recurrence of the mass, however eventually the patient developed deterioration in kidney function due to the long-standing undiscovered obstruction.
Ureteral endometriosis can cause silent obstruction for a long time. Surgical intervention has different modalities according to the type of U.E, and it is the appropriate treatment method for U.E causing complete obstruction to preserve kidney function.
Ureteral endometriosis is a rare but should be included in the differential diagnosis of premenopausal women with ureteral obstruction of unknown cause. Early intervention is critical for better outcomes.
输尿管子宫内膜异位症是一种罕见疾病，其临床表现多样且隐匿，常导致诊断延误和预后较差。
在此，我们报告一位44岁已婚女性，她因右下腹隐痛就诊。CT尿路造影显示右侧输尿管中度积水伴肾积水，怀疑右下输尿管有肿物。诊断性硬性输尿管镜检查显示右下输尿管腔内有一蒂状息肉样肿物，几乎完全阻塞管腔，用钬激光将其完全切除。组织病理学证实为单纯子宫内膜异位组织，未见输尿管组织。随访显示肿物无复发，但最终患者因长期未被发现的梗阻导致肾功能恶化。
输尿管子宫内膜异位症可长期导致隐匿性梗阻。根据输尿管子宫内膜异位症的类型，手术干预有不同方式，对于导致完全梗阻的输尿管子宫内膜异位症，手术是保留肾功能的合适治疗方法。
输尿管子宫内膜异位症虽罕见，但对于不明原因输尿管梗阻的绝经前女性，应将其纳入鉴别诊断。早期干预对于获得更好的预后至关重要。
