Hydronephrosis as a symptom of clinically silent ureteral endometriosis

Czech version

Authors: Lužný R. ¹; H. Heřman ² ; O. Malchar ³ ; R. Pilka ³
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice AGEL Šternberk ¹; Ústav pro péči o matku a dítě Praha, 3. LF UK Praha ²; Porodnicko-gynekologická klinika LF UP a FN Olomouc ³
Published in: Ceska Gynekol 2022; 87(3): 188-192
Category: Case Report
doi: https://doi.org/10.48095/cccg2022188

Overview

Objective: We present two case reports of asymptomatic ureteral endometriosis leading to hydronephrosis. We demonstrate the significance of routine ultrasound scanning of the upper urinary tract in patients with dia gnosed deep infiltrating endometriosis. Case reports: The first case report describes a symptomatic patient after a surgery for deep endometriosis. After the surgery, she was completely without symptoms, but during regular check-ups she developed progressive hydronephrosis on the right side and it did not respond to conservative treatment. Surgery deliberation of the ureter was indicated. The second case report describes a patient with already developed severe hydronephrosis on the left side. The functional kidney examination proved complete renal loss of the left kidney. Because of recurrent pyelonephritis in the nonfunctional kidney, nephrectomy was indicated. Conclusion: Ureteral endometriosis presents a rare, but insidious form of endometriosis, which is very often asymptomatic and diagnosed at a later stage. It can cause a complete silent loss of renal function. Routine ultrasound scanning examination of the upper urinary tract in all patients with diagnosed endometriosis could prevent this severe complication.

Keywords:

hydronephrosis – ureteral endometriosis – routine US scanning

Sources

1. Efe E, Bakacak M, Serin S et al. Hormonal treatment for severe hydronephrosis caused by bladder endometriosis. Case Rep Urol 2014; 2014: 891295. doi: 10.1155/ 2014/ 891295.

2. Berlanda N, Somiglianab E, Frattaruoloa MP et al. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician. Eur J Obstet Gynecol Reprod Biol 2017; 209: 67–71. doi: 10.1016/ j.ejogrb.2016.07. 513.

3. Koninckx PR, Ussia A, Adamyan L et al. Deep endometriosis: defi nition, diagnosis, and treatment. Fertil Steril 2012; 98(3): 564–571. doi: 10.1016/ j.fertnstert.2012.07.1061.

4. Vilos GA, Marks-Adams JL, Vilos AG et al. Medical treatment of ureteral obstruction associated with ovarian remnants and/ or endometriosis: report of three cases and review of the literature. J Minim Invasive Gynecol 2015; 22(3): 462–468. doi: 10.1016/ j.jmig.2014.12.153.

5. Indrielle-Kelly T, Frühauf F, Burgetová A et al. Diagnosis of endometriosis – 3rd part – ultrasound diagnosis of deep endometriosis. Ceska Gynekol 2019; 84(4): 269–275.

6. Carmignani L, Vercellini P, Spinelli M et al. Pelvic endometriosis and hydroureteronephrosis. Fertil Steril 2010; 93(6): 1741–1744. doi: 10.1016/ j.fertnstert.2008.12.038.

7. Mu D, Li X, Zhou G et al. Diagnosis and treatment of ureteral endometriosis: study of 23 cases. Urol J 2014; 11(4): 1806–1812.

8. Indrielle-Kelly T, Frühauf F, Burgetová A et al. Diagnosis of endometriosis – 1st part – overview of diagnostic approaches. Ceska Gynekol 2019; 84(4): 252–259.

9. Barra F, Scala C, Biscaldi E et al. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignit transformation and fertility. Hum Reprod Update 2018; 24(6): 710–730. doi: 10.1093/ humupd/ dmy027.

10. Carfagna P, De Cicco Nardone C, De Cicco Nardone A et al. Role of transvaginal ultrasound in the evaluation of ureteral involvement in deep endometriosis. Ultrasound Obstet Gynecol 2018; 51(4): 550–555. doi: 10.1002/ uog.17524.

11. Huang JZ, Guo HL, Li JB et al. Management of ureteral endometriosis with hydronephrosis: experience from a tertiary medical center. J Obstet Gynaecol Res 2017; 43(10): 1555–1562. doi: 10.1111/ jog.13422.