AUA 2017: Endometriosis – Urinary Tract Involvement and Predictive Factors for Major Surgery

Boston, MA ( Endometriosis affects 5-15% of premenopausal females. Involvement of the urinary tract by endometriosis (UTE) is present in 1-2% of patients. The presented study assessed the severity and surgical treatment of deep infiltrating endometriosis (DIE) with involvement of the urinary tract. Additionally the study also aimed to decipher the existence of predictive factors for major surgery in patients with UTE.

This was a retrospective analysis of 656 women with endometriosis, between January 2005 and August 2016, in a large single academic center. From this cohort, the authors identified a group of 28 (4.3%) patients, with a mean age of 38 ± 6.9 years at diagnosis, who underwent minor or major surgery due to UTE.

Of the 28 patients, only 4 patients (14.3%) were asymptomatic with the most common symptom being lumbar pain, manifesting in 50% of the patients. The mean endometrial lesion size was 2.8 ± 1.7 cm, involving the ureter in 13 patients (46.4%), the bladder in 11 patients (39.3%) and both in the remaining 4 patients (14.3%) patients. The left ureter was the most commonly involved genitourinary organ (35.7%). Hydronephrosis was detected in 18 patients (64.3%) and 12 patients (42.9%) consequently endured some renal function impairment.

Minor surgeries were performed in 12 (42.9%) patients, including TUR, double-J stenting or percutaneous nephrolithotomy, and ureteroscopy. Major surgeries included distal ureterectomy, nephrectomy, and open/laparoscopic excision of endometriomas. Each patient had on average 1.79 ± 1.3 surgeries, and overall 11 patients (39.3%) had more than one surgery. Mean hospitalization time was 6.3 ± 7.4 days. With a mean follow-up of 36.3 months, none of the patients with bladder involvement had a recurrence.

In conclusion, despite being a histologically benign pathology, deep infiltrating endometriosis can have significant consequences affecting the genitourinary tract, likely leading to multiple procedures with a risk of renal function loss. Surgical treatment is highly successful in most cases.

Speaker: Maria José Freire, Coimbra, Portugal

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA