Laparoscopic Ureterolysis in the Management of Deep and Infiltrative Pelvic Endometriosis - Case report

Introduction Endometriosis is defined as the presence of endometrial-like tissue outside the uterine cavity. Affecting primary the pelvic organs, those ectopic implants can cause serious complications. Ureteral involvement is a rare condition, frequently asymptomatic and can cause kidney loss. Here, we present the case of a 34-year-old woman with right side ovarian endometrioma and ureteral stenosis due to fibrosis overlying the right pelvic sidewall, managed by laparoscopic approach. Case presentation 34-year-old infertile woman was diagnosed during routine gynaecological examination with right side ovarian tumor. The vaginal sonography, MRI and urinary ultrasound investigations pointed towards an 8/7 cm right ovarian endometrioma, as well as an asymptomatic right side stage III hydroureteronephrosis with renal cortical thinning. Preoperative management required urologic expertise in the form of ureteral stenting. Laparoscopic inspection revealed a right side ovarian endometrioma adherent to the bowel, pelvic sidewall extensive fibrosis and Douglas pouch obliteration. Laparoscopic cystectomy and extensive adhesiolysis including right ureterolysis were carried out successfully. Pathologic examination of the periureteral excised tissue yielded endometriosis. Conclusions Ureteral involvement in pelvic organ endometriosis can be an unfortunate but rare and ignored pathology. Preoperative evaluation of the urinary tract impairment in patients with endometriosis is important. Laparoscopic surgical approach is based on extent of disease and can be carried out successfully in the hands of a highly experienced laparoscopic surgeon.