Department of Gynecology. Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona. Faculty of Medicine, Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel St., 170, 08036, Barcelona, Spain.
Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
Sci Rep. 2023 Jul 24;13(1):11940. doi: 10.1038/s41598-023-38728-z.
Deep endometriosis (DE) can be more aggressive than other types of endometriosis, and may even lead to irreversible severe complications such as complete unilateral loss of renal function. We aimed to describe the clinical and radiologic characteristics of DE patients diagnosed with irreversible unilateral loss of renal function due to unilateral ureteral stenosis and evaluate risk factors for developing this loss. This retrospective cohort study included 436 patients who underwent laparoscopic DE surgery. We evaluated two groups of patients according to preserved (Non-Renal Loss Group; n = 421) or irreversible unilateral damaged renal function (Renal Loss Group; n = 15). Preoperative epidemiologic variables, clinical characteristics, radiologic findings and surgical treatments of all the patients were collected. The Renal Loss Group had a higher infertility rate and a higher proportion of asymptomatic patients. The following radiological variables showed statistically significant differences between the two groups: mean endometrioma diameter, the presence of intestinal DE and negative sliding sign. Multivariate analysis showed that infertility, being asymptomatic, having intestinal DE or torus uterinus/uterosacral ligament DE and a negative sliding sign significantly increased the risk of loss of renal function. Therefore, among patients with these clinical and/or radiological variables, severe urinary tract obstruction should be specifically ruled out.
深部子宫内膜异位症（DE）比其他类型的子宫内膜异位症更具侵袭性，甚至可能导致不可逆的严重并发症，如单侧肾功能完全丧失。我们旨在描述因单侧输尿管狭窄导致单侧肾功能不可逆丧失而诊断为深部子宫内膜异位症的患者的临床和影像学特征，并评估发生这种丧失的风险因素。这项回顾性队列研究纳入了 436 名接受腹腔镜深部子宫内膜异位症手术的患者。我们根据保留（非肾功能丧失组；n=421）或单侧肾功能不可逆受损（肾功能丧失组；n=15）的情况将两组患者进行评估。收集了所有患者的术前流行病学变量、临床特征、影像学发现和手术治疗情况。肾功能丧失组的不孕率更高，无症状患者比例更高。两组之间的以下影像学变量存在统计学差异：平均子宫内膜异位症囊肿直径、存在肠内深部子宫内膜异位症和阴性滑动征。多因素分析表明，不孕、无症状、存在肠深部子宫内膜异位症或子宫/子宫骶骨韧带深部子宫内膜异位症和阴性滑动征显著增加了肾功能丧失的风险。因此，对于具有这些临床和/或影像学变量的患者，应特别排除严重的尿路梗阻。
