Available online 14 February 2024

To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis

A video article demonstrating a case study and the surgical management

Ureteral endometriosis is a complex form of endometriosis1. If left untreated, the ureter can become significantly compressed leading to hydroureter, hydronephrosis and complete loss of kidney function2.

This is a case of a 29-year-old patient with pelvic pain and cyclical rectal bleeding. Further investigation showed significant left hydronephrosis and almost complete loss of left kidney function (8% on renogram). MRI revealed endometriosis involving the posterior bladder wall and distal left ureter, a large full-thickness sigmoid nodule and a large left endometrioma. The patient underwent a robotic-assisted left nephroureterectomy, partial cystectomy (bladder), excision of pelvic endometriosis and sigmoid resection. This procedure was performed jointly with the gynaecologist, urologist and colorectal surgeon and the SOSURE technique was employed3. The specimen (left kidney, whole length of ureter and bladder wall around ureteric orifice) was removed en-bloc through a small 3cm extension of the umbilical incision. As the distance between the sigmoid nodule and the anal verge was 35cm, which was above the limit of the transanal circular stapler, a limited resection was performed over a discoid excision. The patient made a good recovery post-operatively.

Ureteral endometriosis is an indolent and aggressive condition which can lead to silent kidney loss. It is essential that hydronephrosis and hydroureter is ruled out in cases with deep endometriosis. Isolated hydronephrosis should also prompt a suspicion for endometriosis.

The authors declare no conflict of interests.

No IRB approval was acquired. Patient consent was obtained for the production of this video article.

1. Cunha FL da, Arcoverde FVL, Andres MP, et al. Laparoscopic Treatment of Ureteral Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2021;28(4):779-787. doi:10.1016/j.jmig.2020.11.022

2. Raimondo D, Mabrouk M, Zannoni L, et al. Severe ureteral endometriosis: frequency and risk factors. J Obstet Gynaecol (Lahore). 2018;38(2):257-260. doi:10.1080/01443615.2017.1349083

3. Fleischer K, El Gohari A, Erritty M, Minas V, Khazali S. Excision of endometriosis – optimising surgical techniques.

© 2024 Published by Elsevier Inc. on behalf of AAGL.