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药物治疗逆转子宫内膜异位症所致单侧输尿管梗阻和肾积水

Reversal of Endometriosis-Induced Unilateral Ureteral Obstruction and Hydronephrosis With Medical Therapy.

作者信息

Nguyen Tai, Nguyen Martin, Hoang Thao

机构信息

Obstetrics and Gynecology, Hung Vuong Hospital, Ho Chi Minh, VNM.

Urology, West Virginia School of Osteopathic Medicine, Lewisburg, USA.

出版信息

Cureus. 2024 Nov 19;16(11):e73983. doi: 10.7759/cureus.73983. eCollection 2024 Nov.

DOI:10.7759/cureus.73983
PMID:39703267
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11658911/
Abstract

Endometriosis is a common condition among women of reproductive age worldwide, with the urinary tract being the second most frequently affected extragenital organ system, particularly the bladder and ureters. Ureteral endometriosis (UE) is relatively rare, often asymptomatic, and can lead to progressive renal function loss if not addressed promptly. Early diagnosis and intervention are essential, requiring a high index of suspicion. We present a case of UE in a patient who experienced moderate dysmenorrhea and back pain. Imaging revealed left-sided moderate hydronephrosis and ureteral dilation, suggestive of endometriosis. After a comprehensive consultation, the patient was treated with goserelin. Following three months of regular monitoring, the hydronephrosis and ureteral dilation resolved. She then transitioned to dienogest for six months, followed by the insertion of a levonorgestrel-releasing intrauterine system. This case highlights the effectiveness of hormonal treatments in managing UE, particularly in patients with mild to moderate symptoms who aim to preserve fertility.

摘要

子宫内膜异位症是全球育龄女性的常见病症，泌尿道是第二常见受影响的生殖器外器官系统，尤其是膀胱和输尿管。输尿管子宫内膜异位症（UE）相对罕见，通常无症状，若不及时处理可导致肾功能进行性丧失。早期诊断和干预至关重要，需要高度的怀疑指数。我们报告一例患有中度痛经和背痛的UE患者。影像学检查显示左侧中度肾积水和输尿管扩张，提示子宫内膜异位症。经过全面会诊，患者接受戈舍瑞林治疗。经过三个月的定期监测，肾积水和输尿管扩张消失。然后她改用地诺孕素治疗六个月，随后放置左炔诺孕酮宫内节育系统。该病例突出了激素治疗在管理UE方面的有效性，特别是对于有轻度至中度症状且希望保留生育能力的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/48e8d06eb812/cureus-0016-00000073983-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/008598d5fb49/cureus-0016-00000073983-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/3449cefad752/cureus-0016-00000073983-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/48e8d06eb812/cureus-0016-00000073983-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/008598d5fb49/cureus-0016-00000073983-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/3449cefad752/cureus-0016-00000073983-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f003/11658911/48e8d06eb812/cureus-0016-00000073983-i03.jpg

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本文引用的文献

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Imaging of Urinary Bladder and Ureteral Endometriosis with Emphasis on Diagnosis and Technique.影像学在诊断和技术上对子宫内膜异位症累及膀胱和输尿管的评估
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Urinary endometriosis: MR imaging appearance with surgical and histological correlations.尿路上皮内异症：与手术和组织病理学相关性的 MRI 表现。
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Endometriosis: pathogenesis and treatment.子宫内膜异位症：发病机制与治疗。
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Deep endometriosis: definition, diagnosis, and treatment.深部子宫内膜异位症：定义、诊断和治疗。
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