Record of Minimally Invasive Gynecology
Urinary system involvement in endometriosis involves presence of endometriosis deposits within or around typically the bladder, ureters, urethra, or kidney. Urethral lesions may cause major morbidity while silent lack of reniforme function is common in these patients. Symptoms related to pelvic endometriosis and/or regarding urinary involvement might be often nonspecific. The particular most common studies include menstrual symptoms, flank pain, major hematuria, and pelvic mass.
Ureteric obstruction resulting in hydronephrosis can be a rare symptoms of ureteric endometriosis. It occurs while a consequence involving intrinsic involvement within the ureteric, or from extrinsic data compresion of the ureteric by a pelvic endometrioma. In situations of intrinsic involvement, ectopic endometrial cells is present inside the muscular is usually propria, lamina propriety or ureteric lumen. In extrinsic instances endometriosis occurs within the ureteric adventitia and adjacent smooth tissues only. Extrinsic involvement is approximately 4 times more frequent than intrinsic disease.
Deeply infiltrating Endometriosis (DIE) most often invades the rectovaginal space, uterosacral ligaments, bowel or urinary tract. Hymenoplasty in Turkey was a DIE due to the bilateral ureteric engagement.
Diagnosis of ureteric endometriosis is evasive and relies greatly on clinical hunch. In our situation, patient complained regarding hesitancy of growth typically during menses the rather uncommon presentation of ureteric endometriosis. This indication might be explained by simply enlargement of lively endometriosis tissue close to the ureters. Considering that ureteric endometriosis happens commonly with pelvic endometriosis there is usually a dependence on multidisciplinary management. Progressive ureteric obstruction may be insidious and even bilateral compromise associated with ureters may ultimately result in renal failing. 30% of individuals may have reduced kidney function at the particular time of medical diagnosis that may result within silent kidney damage.
Medical and surgical treatment is available for ureteric endometriosis. Factors affecting treatment choice contain patients’ age, interest in maintaining fertility, seriousness of symptoms and even presence or lack of ureteric obstruction and its particular consequences. Medical therapy may be presented to those seeking to preserve reproductive : capacity or individuals with normal renal performance and no considerable obstruction. In our case surgical administration was decided so that the fresh woman is relieved of the obstruction and prevents future renal damage. More traditional ureterolysis was carried out minimizing morbidity associated with surgery. To be able to reduce the danger of ureteric fibrosis a double T stent was located for 6 months. A check IVP after removal regarding ureteric stents confirmed resolution of the particular obstruction. At 6 months follow upwards, the person is relieved involving her symptoms and even USG KUB indicates normal pelvic clypeal system. She provides been advised and counseled to comply with up regularly keeping a vigilant attention on recurrence.