Elsevier

Fertility and Sterility

Volume 94, Issue 3, August 2010, Pages 856-861
Fertility and Sterility

Endometriosis
Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up

Presented in part at the Joint 2008 Global Congress of Minimally Invasive Gynecology, Las Vegas, Nevada, October 28-November 1, 2008.
https://doi.org/10.1016/j.fertnstert.2009.04.019Get rights and content

Objective

To evaluate surgical outcome and long-term follow-up of conservative laparoscopic management of urinary tract endometriosis (UTE).

Design

Prospective study.

Setting

Tertiary-care university hospital.

Patient(s)

Women with laparoscopic diagnosis and histologic confirmation of urinary bladder or ureteral endometriosis who agreed to undergo long-term follow-up after laparoscopic management.

Intervention(s)

(1) Laparoscopic partial cystectomy for bladder endometriosis. (2) Uretric endometriosis laparoscopically managed by: uretrolysis only; segmental ureterectomy and terminoterminal anastomosis; or segmental ureterectomy and uretrocystoneostomy.

Main Outcome Measure(s)

Variables assessed were: preoperative findings, operative details (type and site of UTE, type of intervention, perioperative complications), and long-term follow-up (persistence/recurrence of preoperative urinary symptoms, if present, and anatomic relapse of the disease).

Result(s)

Mean operating time was 152.8 ± 41.7 minutes. Mean drop in hemoglobin was 1.9 ± 1.6 g/dL. Average hospital stay was 6 days. After surgery, 11 women had fever >38°C and four presented transient urinary retention. During a follow-up period of 36 months, endometriosis recurred in eight patients with no evidence of bladder or ureteral reinvolvement, and there was a significant reduction in the mean score of dysuria and suprapubic pain maintained during the whole follow-up period.

Conclusion(s)

Results of long-term follow-up demonstrate significant reduction in preoperative symptoms with no anatomic relapse

Section snippets

Materials and methods

Full ethical approval of the study protocol was obtained from the local ethics committee.

Between January 2001 and June 2005, 74 consecutive women underwent conservative laparoscopic treatment of urinary tract endometriosis in the Minimally Invasive Gynecologic Surgery Unit of S. Orsola University Hospital in Bologna, a tertiary-level referral center for management of patients with advanced endometriosis. For bladder endometriosis, diagnosis was confirmed when endometrial glands and stroma were

Results

Among the 74 patients confirmed to have UTE and who agreed to be enrolled, 18 women were lost to follow-up and were excluded from the study (five women got pregnant during the first 6 months after surgery, eight women decided to use hormonal treatment for contraceptive purposes during follow-up, and five did not show for follow-up visits). Fifty-six patients were included in the study population: 26 patients had bladder endometriosis, 15 ureteral involvement, and 15 patients had both ureteral

Discussion

The results of this study with a mean follow-up of 3 years support the conclusion that conservative laparoscopic surgical treatment for urinary tract endometriosis provides long-term relief of symptoms and a low rate of anatomic recurrence.

Regarding long-term follow-up, few studies have reported on postoperative evaluation of anatomic relapse and symptom recurrence (Table 3). To the best of our knowledge, the present study is one of the largest series to address specifically surgical outcome

References (34)

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  • Laparoscopic Treatment of Ureteral Endometriosis: A Systematic Review

    2021, Journal of Minimally Invasive Gynecology
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    LUTS were evaluated in 18 studies [10–15,17–23,25–27,29,30], and its prevalence was 21.3% (200 of 937). Ureteral obstructive symptoms, such as lumbar or flank pain, were reported in 14 studies [10–15,17–20,25,26,29,30] and were present in 9.9% (54 of 545) of patients. Ureterohydronephrosis was cited in 19 studies with a total of 1183 patients [9–14,17–24,26,28–30], and it was found in 50.0% (592 of 1183) of patients, ranging from 6% [10] to 100% [11,13,17,18,23].

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R.S. has nothing to disclose. M.M. has nothing to disclose. G.M. has nothing to disclose. L.M. has nothing to disclose. S.C. has nothing to disclose. S.V. has nothing to disclose.

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