Deep-infiltrating endometriosis with primary presentation as obstructive uropathy: report of two cases

Richa Vatsa; Neena Malhotra; Smita Manchanda; Juhi Bharti

doi:10.18203/2320-1770.ijrcog20261633

Authors

Richa Vatsa Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Neena Malhotra All India Institute of Medical Sciences, New Delhi, India
Smita Manchanda Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
Juhi Bharti 1Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261633

Keywords:

Deep infiltrating endometriosis\, Nephrectomy, Obstructive uropathy

Abstract

Endometriosis can have a broad spectrum of presentation and may sometimes affect/encase ureters leading to scarring, adhesion formation and obstruction resulting in backpressure changes in kidneys and ureters. Ureteral endometriosis is generally asymptomatic for long term. By the time symptoms arise, renal damage can be irreversible. Two of our cases had an unusual presentation of flank pain, mimicking urological pathology. Both had obstructive uropathy without any of the typical gynecological features of endometriosis like dysmenorrhea, chronic pelvic pain or infertility. One had a unilateral nonfunctional kidney due to long standing hydroureteronephrosis, for which a nephrectomy was done. In other, obstructive uropathy was managed with bilateral percutaneous nephrostomy. Fertility-preserving surgery for endometriosis was done in both the cases. To conclude, endometriosis can have non-gynecological presentation also. So, in reproductive age females presenting with obstructive uropathy, endometriosis should always be kept as differential diagnosis. Endometriosis can be a silent killer for kidneys.

Author Biography

Neena Malhotra, All India Institute of Medical Sciences, New Delhi, India

Professor and Head, Department of Obstetrics and Gynecology

References

Kołodziej A, Krajewski W, Dołowy Ł, Hirnle L. Urinary tract endometriosis. Urol J. 2015;12(4):2213-7.

Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int. 2013;91:1-9.

Maccagnano C, Pellucchi F, Rocchini L, Ghezzi M, Scattoni V, Montorsi F, et al. Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int. 2012;89:249-58.

Ota K, Sato K, Tanaka M. Ureteral stenosis due to deep infiltrating endometriosis with difficulty in treatment: case report and brief literature review. Gynecol Minim Invasive Ther. 2017;6:214-6.

Nezhat C, Paka C, Gomaa M, Schipper E. Silent loss of kidney secondary to ureteral endometriosis. JSLS. 2012;16:451-5.

Alaoui Mhammedi W, Ouraghi A, Irzi M, El Moudane A, Mokhtari M, Barki A. Ureteral endometriosis presenting as left ureteral obstruction: a case report. Cureus. 2022;14(9):e29288.

Tanaka K, Amoako AA, Gray K, Baartz D. Unilateral ureteric endometriosis at the pelvic brim resulting in complete loss of renal function. Case Rep Obstet Gynecol. 2019:9194615.

Mason RJ, Alamri A, Gusenbauer K, Kapoor A. Intrinsic ureteral endometriosis as a cause of unilateral obstructive uropathy. Can Urol Assoc J. 2016;10(4):119-21.

Choi JI, Yoo JG, Kim SJ, Lee HN, Kim MJ. Acute Renal Failure due to Obstructive Uropathy Secondary to Ureteral Endometriosis. Case Rep Obstet Gynecol. 2015;2015:761348.

Talreja D, Salunke V, Pande S, Gupta C. Successful management of ureteric endometriosis by laparoscopic ureterolysis: a review and report of three further cases. Arab J Urol. 2018;16:342-9.

Wang P, Wang XP, Li YY, Jin BY , Xia D, Wang S et al. Hydronephrosis due to ureteral endometriosis in women of reproductive age. Int J Clin Exp Med. 2015;8(1):1059-65.

Leonardi M, Espada M, Kho M, Magrina JF, Millischer AE, Savelli L, et al. Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment. Diagnostics 2020;10:771.