Ureteral endometriosis: a rare and underdiagnosed cause of renal dysfunction

Swapna Yaramareddy, Kundavi Shankar, Abraham Kurien, Thankam Varma


Ureteral endometriosis is a serious localization of disease that can lead to urinary tract obstruction, hydroureteronephrosis and potential kidney loss. We describe three cases of ureteral endometriosis where there was documented renal function loss with subsequent workup and surgical intervention. Clinical suspicion and preoperative assessment may help with diagnosis and allows for a multidisciplinary pre-consultation. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Laparoscopic surgical approach can be carried out successfully in the hands of an experienced laparoscopic surgeon. These cases illustrate varying surgical approaches tailored to management of ureteral endometriosis. Women in reproductive age presenting with pelvic pain diagnosed to have hydronephrosis must be adequately evaluated for ureteral endometriosis.


Endometriosis, Laparoscopic surgery, Ureteroneocystotomy, Ureteral endometriosis, Ureterolysis

Full Text:



Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362:238-98.

Comiter CV. Endometriosis of the urinary tract. Urol Clin North Am. 2002;29:625-35.

Abrao MS, Dias JA Jr, Bellelis P, Podgaec S, Bautzer CR, Gromatsky C. Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril. 2009;91:1662-7.

Donnez J, Nisolle M, Squifflet J. Ureteral endometriosis: a complication of rectovaginalendometriotic (adenomyotic) nodules. Fertil Steril. 2002;77:32-7.

Kondo W, Branco AW, Trippia CH, Ribeiro R, Zomer MT. Retrocervical deep infiltrating endometriotic lesions larger than thirty millimeters are associated with an increased rate of ureteral involvement. J Minim Invasive Gynecol. 2013;20:100-3.

Horn LC, Do Minh M, Stolzenburg JU. Intrinsic form of ureteral endometriosis causing ureteral obstruction and partial loss of kidney function. Urol Int. 2004;73:181-4.

Nap AW, Groothuis PG, Demir AY, Evers JL, Dunselman GA. Pathogenesis of endometriosis. Best Pract Res Clin Obstet Gynaecol. 2004;18:233-44.

Sasson IE, Taylor HS. Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci. 2008;1127:106-15.

Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, et al. Deeply in ltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod. 2006;21:1839-45.

Gabriel B, Nassif J, Trompoukis P, Barata S, Wattiez A. Prevalence and management of urinary tract endometriosis: a clinical case series. Urol. 2011;78:1269-74.

Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16:285e98.

Balleyguier C, Roupret M, Nguyen T, Kinkel K, Helenon O, Chapron C. Ureteral endometriosis: the role of magnetic resonance imaging. J Am Assoc Gynecol Laparosc. 2004;11:530e6.

Nezhat C, Nezhat F, Nezhat CH, Nasserbakht F, Rosati M, Seidman DS. Urinary tract endometriosis treated by laparoscopy. Fertil Steril. 1996;66:920e4.

Yohannes P. Ureteral endometriosis. J Urol. 2003;170:20e5.

Ghezzi F, Cromi A, Bergamini V, Serati M, Sacco A, Mueller MD. Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil Steril. 2006;86:418e22.