Lu Yujuan, Wang Yu
Department of Gynecology, Clinical Medical College & Affiliated Hospital of Chengdu University, No. 82, North Second Section, Second Ring Road, Chengdu, 610041, China.
BMC Urol. 2025 Jul 9;25(1):164. doi: 10.1186/s12894-025-01866-9.
To explore the necessity of long-term pharmacological management following total hysterectomy for adenomyosis.
A case of ureteral endometriosis identified over one year after laparoscopic total hysterectomy and bilateral salpingectomy for adenomyosis was retrospectively analyzed. Clinical data were reviewed, and related literature was summarized for discussion.
The patient underwent laparoscopic total hysterectomy and bilateral salpingectomy at our hospital more than one year prior because of adenomyosis. No pharmacological treatment was provided postsurgery. One year later, the patient presented with right lumbar discomfort. Imaging revealed hydronephrosis of the right kidney and dilation of the right ureter, leading to a diagnosis of right ureteral endometriosis. Laparoscopic excision of the ureteral endometriotic lesion was performed. Pathology confirmed right ureteral endometriosis with glandular cystic expansion. Postsurgery, the patient was treated with gonadotropin-releasing hormone agonist (GnRH-a) therapy (3.6 mg of goserelin via subcutaneous injection every 28 days for a total of six cycles). Treatment is ongoing. Follow-up ultrasound revealed no abnormalities in the kidneys or ureters, and no recurrence was observed during the five months of follow-up.
Adenomyosis is often associated with deep endometriosis. Even if no evident deep pelvic endometriosis is identified during total hysterectomy, long-term pharmacological management postsurgery may still be necessary. This approach can reduce the incidence of deep endometriosis in organs such as the bladder, ureters, and intestines.
探讨子宫腺肌病全子宫切除术后长期药物治疗的必要性。
回顾性分析1例因子宫腺肌病行腹腔镜全子宫切除术及双侧输卵管切除术后1年以上发现的输尿管子宫内膜异位症病例。查阅临床资料，并总结相关文献进行讨论。
该患者1年多前因子宫腺肌病在我院接受腹腔镜全子宫切除术及双侧输卵管切除术。术后未进行药物治疗。1年后，患者出现右腰部不适。影像学检查显示右肾积水及右输尿管扩张，诊断为右输尿管子宫内膜异位症。行腹腔镜下输尿管子宫内膜异位病灶切除术。病理证实为右输尿管子宫内膜异位症伴腺囊性扩张。术后，患者接受促性腺激素释放激素激动剂（GnRH-a）治疗（每28天皮下注射戈舍瑞林3.6mg，共6个周期）。治疗仍在进行中。随访超声显示肾脏和输尿管无异常，随访5个月未观察到复发。
子宫腺肌病常与深部子宫内膜异位症相关。即使在全子宫切除术中未发现明显的深部盆腔子宫内膜异位症，术后长期药物治疗可能仍有必要。这种方法可以降低膀胱、输尿管和肠道等器官深部子宫内膜异位症的发生率。
