Infiltrative vesical and ureteral endometriosis: Two different points of view.

摘要

A 41-year-old woman reported right loin pain, dysuria, and hematuria. Cystoscopy and ureteroscopy revealed a 3-cm endometriotic nodule involving the bladder mucosa near the right ureteral orifice with resultant ureteral narrowing. A double-J stent was passed. Excision of this nodule (Figure 1) and laparoscopic extravesical neoureterocystos-tomy were performed. Concurrent cystoscopy helped definethe lesion margins during excision (Figure 2). Postoperative intravenous urethrography after removal of the ureteral stent was normal.The urinary tract is affected in approximately 2% of women with endometriosis.1 When the ureter is involved, it appears to affect the extrinsic aspect more commonly.2 In this case the endometriosis behaved as a progressive, infiltrative disease, thus early diagnosis and treatment was necessary to avoid ureteral obstruction and possible subsequent loss of renal function. Laparoscopic neoureterocystotomy has been performed only in very small numbers, the first by Ehrlich and Gershman in 1993.