Ureter Endometriosis

Ureteral Endometriosis – A Comprehensive Guide

What is Ureteral Endometriosis?

Ureteral endometriosis is a rare but serious form of deep infiltrative endometriosis caused by the implantation of endometrial tissue around or within the wall of the ureter. It can progress silently and lead to kidney function loss.

How Does It Occur?

As endometrial cells spread in the pelvic cavity, fibrotic tissue and lesions form around the ureter. The left ureter is most commonly affected, and it is often associated with other pelvic endometriosis foci.

Types

Ureteral endometriosis occurs in two forms:
- Extrinsic: The ureter is compressed externally (most common)
- Intrinsic: There is invasion into the ureteral wall (rarer but more serious)

Symptoms

Most patients may be asymptomatic. Back pain, groin pain, pain that increases with menstruation, and rarely urinary complaints may be observed.

Risk of Silent Kidney Loss

If ureteral obstruction is not detected for a long time, it can lead to hydronephrosis and loss of kidney function. Therefore, early diagnosis is critically important.

How is it Diagnosed?

Evaluation is performed with ultrasound, MRI, and especially urinary system imaging (IVP, CT). The presence of hydronephrosis is an important finding.

Ultrasound Findings

Hydronephrosis and ureteral dilation may be observed. However, a direct lesion may not always be visible.

MRI Findings

Fibrotic, T2 hypointense lesions and areas of narrowing may be observed around the ureter. This is important for surgical planning.

Treatment Approach

Treatment is mostly surgical. Medical treatment can provide symptom control but does not correct mechanical obstruction.

Surgical Treatment

Techniques such as ureterolysis (mobilization/release), segmental resection, and ureteral reimplantation can be applied. It is planned according to the extent of the disease.

Multidisciplinary Approach

In patients with ureteral involvement, surgical planning must be done in conjunction with urology.

Conclusion

Ureteral endometriosis is a rare but serious condition that can lead to severe complications. With early diagnosis and appropriate surgical intervention, kidney functions can be preserved.