Centre for Endometriosis and Minimally Invasive Gynaecology, HCA The Lister Hospital, Chelsea Bridge Road (Drs. Khazali, Nisar, Bachi, and Adamczyk), London, United Kingdom.
Guys and St Thomas NHS Foundation Trust, Great Maze Pond (Dr. Nair), London, United Kingdom.
J Minim Invasive Gynecol. 2024 May;31(5):368. doi: 10.1016/j.jmig.2024.02.002. Epub 2024 Feb 14.
To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis.
A video article demonstrating a case study and the surgical management.
Ureteral endometriosis is a complex form of endometriosis [1]. If left untreated, the ureter can become significantly compressed leading to hydroureter, hydronephrosis and complete loss of kidney function [2].
This is a case of a 29-year-old patient with pelvic pain and cyclical rectal bleeding. Further investigation showed significant left hydronephrosis and almost complete loss of left kidney function (8% on renogram). MRI revealed endometriosis involving the posterior bladder wall and distal left ureter, a large full-thickness sigmoid nodule and a large left endometrioma. The patient underwent a robotic-assisted left nephroureterectomy, partial cystectomy (bladder), excision of pelvic endometriosis and sigmoid resection. This procedure was performed jointly with the gynecologist, urologist, and colorectal surgeon and the SOSURE technique was employed [3]. The specimen (left kidney, whole length of ureter and bladder wall around ureteric orifice) was removed en-bloc through a small 3cm extension of the umbilical incision. As the distance between the sigmoid nodule and the anal verge was 35cm, which was above the limit of the transanal circular stapler, a limited resection was performed over a discoid excision. The patient made a good recovery postoperatively.
Ureteral endometriosis is an indolent and aggressive condition which can lead to silent kidney loss. It is essential that hydronephrosis and hydroureter is ruled out in cases with deep endometriosis. Isolated hydronephrosis should also prompt a suspicion for endometriosis.
强调因子宫内膜异位症而行肾输尿管切除术和部分膀胱切除术的病例。
展示病例研究和手术管理的视频文章。
输尿管子宫内膜异位症是一种复杂的子宫内膜异位症形式[1]。如果不治疗，输尿管会受到严重压迫，导致输尿管积水、肾积水和肾功能完全丧失[2]。
这是一名 29 岁患者的病例，表现为盆腔疼痛和周期性直肠出血。进一步的检查显示左侧输尿管严重积水，左肾功能几乎完全丧失（肾图显示 8%）。磁共振成像（MRI）显示子宫内膜异位症累及膀胱后壁和左侧输尿管远端，乙状结肠有一个大的全层结节和一个大的左侧子宫内膜瘤。患者接受了机器人辅助左肾输尿管切除术、部分膀胱切除术（膀胱）、盆腔子宫内膜异位症和乙状结肠切除术切除。该手术由妇科医生、泌尿科医生和结直肠外科医生共同完成，并采用 SOSURE 技术[3]。标本（左肾、全长输尿管和输尿管口周围的膀胱壁）通过脐部小 3cm 延长切口整块切除。由于乙状结肠结节和肛门缘之间的距离为 35cm，超出了经肛门圆形吻合器的限制，因此进行了有限的切除，切除范围为盘状切除。术后患者恢复良好。
输尿管子宫内膜异位症是一种惰性和侵袭性疾病，可导致肾脏无声性丧失。对于深部子宫内膜异位症病例，必须排除肾积水和输尿管积水。孤立性肾积水也应提示子宫内膜异位症的可能性。
