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  Table of Contents 
Year : 2017  |  Volume : 33  |  Issue : 4  |  Page : 276-282

Ureteral endometriosis: A systematic literature review

1 Department of Obstetrics and Gynecology, Diakonie-Klinikum Schwäbisch Hall gGmbH, Schwäbisch Hall, Germany
2 Department of Surgery, Vascular Unit, Laiko General Hospital, Medical School of Athens, Athens 11527, Greece
3 Department of University Urology Clinic, Laiko Hospital, University of Athens, Athens 11527, Greece

Date of Submission11-Apr-2017
Date of Acceptance05-Sep-2017
Date of Web Publication27-Sep-2017

Correspondence Address:
Viktoria-Varvara Palla
Department of Obstetrics and Gynecology, Diakonie-Klinikum Schwäbisch Hall gGmbH, Schwäbisch Hall
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iju.IJU_84_17

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Introduction: Ureteral endometriosis is a rare disease affecting women of childbearing age which presents with nonspecific symptoms and it may result in severe morbidity. The aim of this study was to review evidence about incidence, pathogenesis, clinical presentation, diagnosis, and management of ureteral endometriosis.
Materials and Methods: PubMed Central database was searched to identify studies reporting cases of ureteral endometriosis. “Ureter” or “Ureteral” and “Endometriosis” were used as key words. Database was searched for articles published since 1996, in English without restrictions regarding the study design.
Results: From 420 studies obtained through database search, 104 articles were finally included in this review, including a total of 1384 patients with ureteral endometriosis. Data regarding age, location, pathological findings, and interventions were extracted. Mean patients' age was 38.6 years, whereas the therapeutic arsenal included hormonal, endoscopic, and/or surgical treatment.
Conclusions: Ureteral endometriosis represents a diagnostic and therapeutic challenge for the clinicians and high clinical suspicion is needed to identify it.

How to cite this article:
Palla VV, Karaolanis G, Katafigiotis I, Anastasiou I. Ureteral endometriosis: A systematic literature review. Indian J Urol 2017;33:276-82

How to cite this URL:
Palla VV, Karaolanis G, Katafigiotis I, Anastasiou I. Ureteral endometriosis: A systematic literature review. Indian J Urol [serial online] 2017 [cited 2022 May 25];33:276-82. Available from:

   Introduction Top

Endometriosis is an important gynecologic clinical disorder characterized by the ectopic presence and growth of functional endometrial tissue, glands, and stroma, outside the uterus, clinically associated with pelvic pain and infertility.[1] While the true incidence of this clinical entity cannot be exactly known since a large proportion of the affected women are asymptomatic, it is estimated to be about 5%–20%. The organs most commonly involved include the ovaries, the uterosacral ligaments, the  Fallopian tube More Detailss, the cervix, and the cul-de-sac.[2] Endometriosis can be classified as ovarian, peritoneal, or deep infiltraring endometriosis, with the latter defined as the presence of a lesion infiltrating 5 mm or more into the peritoneum.[3] Another classification based on the number, size, and superficial and/or deep location of endometrial implants, plaques, endometriomas and/or adhesions has been established by the American Society for Endometriosis and is as follows: stage I (minimal-points 1–5), stage II (mild-points 6–15), stage III (moderate– points 16–40), and stage IV (severe– points >40).[4] The endometriotic cells may originate from retrograde menstruation, blood and lymphatic dissemination, stem cells, and metaplasia of coelomic epithelium.[4] We present the clinical appearance of endometriosis in the ureter(s), the steps to diagnosis and treatment options through a review of the literature.

   Materials and Methods Top

Data collection

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this systematic review. Medline was systematically searched, and thereafter, we performed a snowball process in the reference lists of the eligible articles for additional titles.

Search methodology

A thorough search of the English language literature published from 1996 until August 2017 was performed to identify studies relative to ureteral endometriosis. The search strategy explored medical subject heading terms in all possible combinations: “Endometriosis” and “ureteral” or “ureter.” Each title and abstract of studies were evaluated and selected according to relevance and inclusion criteria. The electronic search was supplemented and expanded using the “related articles” function of the search engine and with manual search of the relevant articles. The study selection and data extraction were performed by two investigators (VP, GK), and the full texts of the studies were retrieved. Discrepancies were rechecked, and consensus was achieved by discussion. After locating and reading 420 abstracts online, relevant articles were printed to permit thorough reading. After full-texts analysis, 235 articles were excluded because they met exclusion criteria while 185 were selected for inclusion [Figure 1].
Figure 1: Summarizing literature search results

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One hundred and four articles were finally included in this review: 5 prospective studies and 99 retrospective, of which 62 were case reports. A total of 1384 patients (mean age 38.6 years) with ureteral endometriosis were evaluated and data on age, side affected, histological type, and management are included in [Supplementary Table 1] [Additional file 1] (available online only at

Inclusion and exclusion criteria

Eligibility for inclusion was limited to papers referring specifically to patients having ureteral endometriosis, and including data regarding age, side affected, histology, and intervention. Articles were excluded if they referred only to endometriosis located in other organs or when the referable data were mixed. Furthermore, reviews and letters were also excluded.

   Results Top


Ureteral endometriosis is a rare disease first described by Cullen in 1917, constituting 0.1%–0.4% of genitourinary tract endometriosis.[5],[6] Ureters are the second most common site of the urinary tract affected by endometriosis with a ratio of bladder/ureter/kidney/urethral endometriosis of 40:5:1:1, whereas an increase in incidence is observed over the years probably because of the increased diagnosis.[7],[8] On the other hand, the fact that the disease can also run asymptomatically or present with nonspecific symptoms may lead to an underestimation of the prevalence of this clinical entity.

Pathogenesis and histopathology

The pathogenesis of endometriosis and more specifically of ureteral involvement has been widely investigated; however no single theory explains the clinical entity. The most common theory is that of retrograde menstruation,[9],[10] which also explains the asymmetrical localization of ureteral endometriosis. The sigmoid colon contributes to the creation of an isolated microenvironment around the left adnexa. Macrophages, the first line of the immune system cannot reach the endometrial cells coming from the left fallopian tube into the peritoneal environment. On the right side, the cecum cannot provide such protection because of its more cranial anatomical position. The above-mentioned asymmetry has also been correlated with the presence of ovarian endometriosis indicating a common pathogenesis of ovarian and ureteral endometriosis or the development of ureteral lesions as a subsequent implantation arising from the ovaries. In addition, the propensity for endometriotic lesions to affect the distal ureter more frequently than the proximal ureter could also be explained by the retrograde menstruation theory, explaining the implantation of endometriotic cells under the influence of gravity.[11]

The second theory is the embryonal one. According to this, endometriosis may develop primarily in the retroperitoneum from the embryonic remains of the Mullerian duct. A further spread of the disease up to and around the ureter may be explained by the proliferation of smooth muscle surrounding the ureteral wall.[8],[9]

Benign metastasis could also potentially provide a theory for some cases of endometriosis, wherein endometrial cells from within the uterus circulate through the lymphatic or blood vessels and spread to distant parts of the body.[12]

In addition, other hormonal and molecular pathways play an important and complicated role in the pathophysiology of deep endometriotic lesions in the ureters. The presence and survival of ectopic endometrial tissue in deep endometriotic lesions require a type of immunotolerance. Sphingosine-1-phosphate receptor 1 axis plays a particular role in this process, receiving several stimuli such as growth factors (EGFR, VEGFR, and NGFR), hormones, chemokines, cytokines, and reactive oxygen species and inducing interleukin (IL) 1b, tumor necrosis factor-alpha (TNF-α). Cytokines such as IL-1b or IL-33, which are elevated in deep infiltraring endometriosis (DIE), have further immunomoderative effects. In addition, DIE lesions demonstrate an overexpression of prostaglandin endoperoxide synthase 2 (PTGS2), which in turn leads to an increase in the production of PGF2a and PGE2 from endometrial cells. This fact, in combination with the upregulation of prostaglandin receptors leads to the presence of high concentrations of prostaglandins in DIE.[13],[14],[15],[16]

The hormonal background is also different in DIE lesions, which show an increased estrogen biosynthesis and a decreased inactivation through the following mechanisms; upregulation of aromatase (converts androgens to estradiol E2), downregulation of 17b-hydrosteroid dehydrogenase type 2 (HSD17B2) (converts E2 to the less active metabolite estrone), increase of 17b-hydrosteroid dehydrogenase type 1 (HSD17B1) messenger RNA (E2 with increased tissue concentration), and upregulation of the expression of estrogen receptor (ER) β (suppression of ERa expression and consequently E2 inhibition of progesterone expression dominates against its stimulation).

On the other hand, DIE tissues show progesterone resistance, which in turn leads to decreased expression of HSD17B2 and downregulation of estrogen metabolism. In addition, estradiol in combination with TNF-a (Tumor necrosis factor-alpha) induces while progesterone inhibits the activation of NF-kB, which has antiapoptotic functions.

The hormonal milieu of DIE lesions is responsible for their resistance to progesterone's antiproliferative effects and subsequently for survival of the endometriotic cells.

A favorable invasion microenvironment is also created by the upregulation of matrix metalloproteinase MMP-3, TGF-b, and other cytokines. Oxidative stress and neuroangiogenetic mechanisms were also found to be involved in the pathogenesis of DIE increased proliferative (reactive oxygen species), extracellular regulated kinase, and advanced oxidation protein product, and increased expression of neurangiogenesis genes including nerve growth factor, vascular endothelial growth factor, and intercellular adhesion molecule activity of oxidative stress of NF-kB, reactive oxygen species.[4]

Histopathologically, two major types of endometriosis are recognized according to the grade of infiltration of the ureteral wall: intrinsic and extrinsic.[7] In the extrinsic type, the endometrial tissue invades the ureteral adventitia and/or the surrounding connective tissue. As a result, ureteral obstruction and hydronephrosis are common. In the intrinsic type, the ectopic endometrial tissue, apparently through lymphatic or venous metastasis, is found in the muscularis mucosa and the uroepithelium. Nevertheless, the two types may occur simultaneously.[7],[17],[18],[19]


Ureteral endometriosis presents a diagnostic challenge. Many medical specialties may be involved since the patients complain of non-specific symptoms. Most patients present with incapacitating dysmenorrhea, dyspareunia, pelvic pain, symptoms related with the involvement of rectovaginal septum, uterosacral ligaments, broad ligaments, and the ovaries.[20],[21],[22] Ureteral endometriosis may also cause more specific symptoms associated with the urinary tract such as flank or abdominal pain, renal colic, hematuria associated with flank pain, or cyclic gross hematuria. Unexplained hypertension and silent renal failure may also occur as the disease may run asymptomatic for a long time. Risk of renal failure in this cases is as high as 25%–50%.[18],[23]

Considering that the symptoms are either non-specific or absent initally, a high index of clinical suspicion is required when patients of childbearing age have such a clinical presentation. This is why evaluation of the urinary tract is suggested when deep infiltrating endometriosis is suspected and more particularly if the rectovaginal septum is affected by nodules of >3 cm.[24] It is found that patients with rectocervical endometriosis have a 7-fold greater chance of having ureteral endometriosis, whereas patients with rectum-sigmoid endometriosis have a 22-fold greater chance.[25]

Physical examination

While there may be no physical findings, large endometriotic nodules may be palpated in the rectovaginal septum and their presence is highly related to ureteral endometriosis.[24]


Serum Ca125 may be elevated in endometriosis but is neither sensitive nor specific for ureteral endometriosis.[26] Renal function should be assessed and urine should be examined for hematuria, and cytology to rule out malignant disease.

There are no specific diagnostic tests and the extent of the disease cannot be accurately estimated preoperatively. A step-by-step algorithm is proposed [Table 1]. A vaginal ultrasound may reveal the presence of ovarian endometriomas and/or nodules at the rectovaginal septum. Abdominal ultrasound can identify urinary tract obstruction. In case of normal findings, a kidney ultrasound should be obtained regularly in follow-up. Computed tomography has limited use in the diagnostis of ureteral endometriosis because of the high cost, poor specificity, and high radiation dose, which is avoidable for patients of childbearing age.[7]
Table 1: Step-by-step diagnosis of ureteral endometriosis

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Magnetic resonance imaging (MRI) allows assessment of disease extension in the pelvis and ureteric involvement and is the investigation of choice.[27],[28],[29],[30] It allows evaluation of all endometriotic locations and can potentially distinguish intrinsic from extrinsic form of ureteral endometriosis and thus help decide the surgical approach.[31] In addition, MRI appears to be more sensitive (91% vs. 82%) but less specific (59% vs. 67%) than surgery for the diagnosis of intrinsic ureteral endometriosis.[32]

Isotope renography should be used to assess any patient with suspected ureteral endometriosis to evaluate renal function.[33],[34] It is reported that 25%–50% of the nephrons are lost, and almost 30% of the patients present with reduced kidney function at the time of the diagnosis.[35]

Ureteroscopy is used to diagnose intrinsic endometriosis, although negative findings do not exclude the presence of ureteral endometriosis Apart from the macroscopic recognition of endometriotic lesions, which may appear as edematous and irregular with different shapes and colors, ureteroscopy allows biopsy, histological confirmation and ablation.[30],[36],[37] It may also reveal multifocality of the disease and helps measure the distance between the lower endometriotic margins and ureteral orifices which is of fundamental significance for the choice of surgical approach.[38],[39]

Most commonly ureteral endometriosis is found accidentally in patients undergoing laparoscopy for infertility and/or endometriosis.


Ureteral endometriosis is an uncommon clinical entity that affects young women of childbearing age with severe symptoms and/or infertility. Because of the rarity of the disease and the lack of prospective randomized studies, there are no clear guidelines for treatment. Each patient should be individually managed after a multidisciplinary team approach, including a skilled laparoscopic gynecologist, urologist, and colorectal surgeon. The therapeutic arsenal includes both conservative and operative treatments [Table 2]. The choice depends on the onset and renal function and the issues are: (1) relief of symptoms (2) renal preservation, and (3) prevention of relapse.
Table 2: Ureteral endometriosis: Therapeutic management

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Hormonal therapy

Hormonal therapy includes danazol, GnRH agonists (leuprolide, goserelin), medroxyprogesterone, estrogen-progestin combination, and progestin alone. The most popular between are danazol and GnRH agonists, which antagonize the effect of gonadotropin, entailing the eventual effect of inhibition of ovarian function. In addition, local progestogens in the form of intrauterine levonogestrel device lead to a high concentration of the drug at the endometrium and are effective in the management of pelvic and vesicovaginal septum endometriosis. The 5-year effectiveness in combination with preservation of fertility after cessation of therapy is simlar to intrauterine levonorgestrel devices.[40],[41]

The best candidates for hormonal therapy are: (a) patients of childbearing age who desire pregnancy, with close follow-up with ultrasound at 6-month intervals to rule out an obstruction,[7] (b) patients without significant fibrosis in combination with the suitable surgical intervention,[30],[36] and (c) postmenopausal women, under close follow-up.[39] Hormonal therapy functions through the shrinkage of affected tissues. It does not prevent the formation of fibrous tissue and adhesions. As a consequence, ureteral obstruction and hydroureteronephrosis may still occur.[42],[43] Medical management alone is clearly contraindicated in the setting of ureteral obstruction and hydronephrosis, and medical management alone might not be a good option for ureteric endometriosis given the increased incidence of recurrence with the serious potential sequelae of reduced renal function.[7]

Moreover, the response to hormonal therapy may not be complete. A possible explanation is the desmoplastic reaction within the muscle layers and the serosa of the ureter due to repetitive bleeding and resorption of menstrual debris. In addition, the side effects of hormonal therapy are a reason for low compliance. The relapse rate is also high (55%) after treatment cessation.[44] Therefore conservative treatment is considered as palliative for deep infiltrative endometriosis.

Invasive therapy

Endoscopic management

Ureteroscopic management is indicated in patients with intraluminal endometriosis. Ureteroscopy allows ablation with laser, and balloon dilatation with stent placement.[38],[45],[46] However, this is often not curative and follow-up imaging, including ureteroscopic surveillance and retrograde urography, is recommended to early detect disease recurrence and/or progression.

Operative management

Conventionally, laparotomy was the approach of choice for the treatment of extensive ureteral endometriosis.[47] Laparoscopy, through a magnified view, allows greater ability to identify the extent of the disease.[48],[49] In both cases, the preoperative ureteric stent is recommended as it functions as a guide for the identification of the ureter and the prevention of ureteral injury.

Operative approaches for ureteral endometriosis include ureterolysis, ureteral resection with ureteral reconstruction, and nephrectomy in cases of renal insufficiency. The choice of the suitable technique is based on the type of ureteral endometriosis (intrinsic vs extrinsic) and the location and the extent of the disease.


Ureterolysis is indicated in cases of extrinsic endometriosis with lesions <3 cm when not associated with hydroureteronephrosis.[20],[50] Intrinsic endometriosis is a contraindication for ureterolysis since it is associated with high recurrence rates (16%) and ureteral restenosis. Patients should be warned about the possible need for reintervention and/or progressive renal failure, in combination with the need for close follow-up.[48],[51]

Ureteral resection with ureteral reconstruction

Ureteral resection with ureteral reconstruction is considered in cases of intrinsic endometriosis, lesions longer than 3 cm situated below the level of the iliac vessels and hydroureteronephrosis.[48] The two basic techniques include the ureteral-ureteral anastomosis and ureteroneocystostomy.

The first technique should be performed if the ureteral stenosis is limited to the ovarian fossa and distal ureter can be preserved.[52],[53],[54],[55],[56],[57]

Ureteroneocystostomy is the operation of choice in cases of extended disease with ureteral stenosis close to the vesicoureteral junction.[53],[58],[59],[60],[61] The Lich-Gregoire, Leadbetter–Politano or a psoas hitch technique may be used.[62],[63],[64] Rarely, replacement with bowel segments or bladder fi‚aps may be required.[65],[66] A successful series of five laparoscopic nonrefi‚uxing extravesical Lich-Gregoir reimplantations with no intra- or post-operative complications and a 100% success rate in accordance with the previous literature for open surgery has been reported.[67],[68],[69] Ureterocystoneostomy with the vesico-psoas hitch technique places the ureter away from the pelvis, the frequent site of recurrence.[59] Tension-free anastomosis is needed to reduce the risk of postoperative recurrence of stenosis and hydronephrosis.[70] Despite the modification of the anatomy of the urinary tract, the urodynamic parameters do not change.[71] The effectiveness of the psoas hitch and ureteral reimplantation in open surgery has been proven by multiple reports in the literature, with good results at follow-up.[71],[72],[73],[74],[75] On the other hand, Gozen et al. reported their series of laparoscopic psoas hitch and concluded that it is a versatile procedure with multiple indications and associated with excellent results.[69] In addition, Rassweiler et al., in a retrospective comparison with open surgery, report a functional success rate of 10 out of 10 in the laparoscopic group.[74]


Nephrectomy is necessary in cases of deteriorated renal function, which unfortunately still occurs despite the surgical techniques developed and in cases when the lesions mimic an urothelial carcinoma.[63]

   Conclusions Top

Ureteral endometriosis is a challenging disease presenting most commonly with nontypical symptoms and signs and may consequently lead to significant morbidity and most importantly renal function deterioration. The diagnosis should be suspected when women of childbearing age appear with atypical urological symptoms combined with symptoms indicative of deep pelvic endometriosis. Preoperative imaging is helpful for the planning of the operative management. Surgery depends on the type, extent, and location of the disease, and a laparoscopic approach is preferred. Surgical management is effective in relieving symptoms and improving fertility. For the best results, a multidisciplinary approach from an experienced gynecologist, urologist, and general surgeon is advised.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

   References Top

Baldi A, Campioni M, Signorile PG. Endometriosis: Pathogenesis, diagnosis, therapy and association with cancer (review). Oncol Rep 2008;19:843-6.  Back to cited text no. 1
Viganò P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: Epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2004;18:177-200.  Back to cited text no. 2
Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: Histology and clinical significance. Fertil Steril 1990;53:978-83.  Back to cited text no. 3
Tosti C, Pinzauti S, Santulli P, Chapron C, Petraglia F. Pathogenetic mechanisms of deep infiltrating endometriosis. Reprod Sci 2015;22:1053-9.  Back to cited text no. 4
American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997;67:817-21.  Back to cited text no. 5
Cullen TS. Adenomyoma of the tect-vaginal septum. Bull Johns Hopkins Hosp 1917;28:343.  Back to cited text no. 6
Yohannes P. Ureteral endometriosis. J Urol 2003;170:20-5.  Back to cited text no. 7
Somigliana E, Vercellini P, Gattei U, Chopin N, Chiodo I, Chapron C, et al. Bladder endometriosis: Getting closer and closer to the unifying metastatic hypothesis. Fertil Steril 2007;87:1287-90.  Back to cited text no. 8
Hansen KA, Chalpe A, Eyster KM. Management of endometriosis-associated pain. Clin Obstet Gynecol 2010;53:439-48.  Back to cited text no. 9
Takagi H, Matsunami K, Ichigo S, Imai A. Novel [corrected] medical management of primary bladder endometriosis with dienogest: A case report. Clin Exp Obstet Gynecol 2011;38:184-5.  Back to cited text no. 10
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98:511-9.  Back to cited text no. 11
Burney RO, Giudice LC. The pathogenesis of endometriosis. In:Nezhat C, Nezhat F, Nezhat C, editors. Nezhat's Video-Assisted and Robotic-Assisted Laparoscopy and Hysteroscopy. New York: Cambridge University Press; 2013. p. 252-8.  Back to cited text no. 12
Lambert S, Santulli P, Chouzenoux S, et al. Endometriosis: Increasing concentrations of serum interleukin-1b and interleukin-1sRII is associated with the deep form of this pathology. J Gynecol Obstet Biol Reprod (Paris) 2014;43:735-43.  Back to cited text no. 13
Santulli P, Borghese B, Noël JC, Fayt I, Anaf V, de Ziegler D, et al. Hormonal therapy deregulates prostaglandin-endoperoxidase synthase 2 (PTGS2) expression in endometriotic tissues. J Clin Endocrinol Metab 2014;99:881-90.  Back to cited text no. 14
Bukulmez O, Hardy DB, Carr BR, Word RA, Mendelson CR. Inflammatory status influences aromatase and steroid receptor expression in endometriosis. Endocrinology 2008;149:1190-204.  Back to cited text no. 15
Banu SK, Lee J, Speights VO Jr., Starzinski-Powitz A, Arosh JA. Selective inhibition of prostaglandin E2 receptors EP2 and EP4 induces apoptosis of human endometriotic cells through suppression of ERK1/2, AKT, NFkappaB, and beta-catenin pathways and activation of intrinsic apoptotic mechanisms. Mol Endocrinol 2009;23:1291-305.  Back to cited text no. 16
de Ziegler D, Gayet V, Aubriot FX, Fauque P, Streuli I, Wolf JP, et al. Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes. Fertil Steril 2010;94:2796-9.  Back to cited text no. 17
Abrao MS, Dias JA Jr., Bellelis P, Podgaec S, Bautzer CR, Gromatsky C, et al. Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril 2009;91:1662-7.  Back to cited text no. 18
Seracchioli R, Mabrouk M, Montanari G, Manuzzi L, Concetti S, Venturoli S, et al. Conservative laparoscopic management of urinary tract endometriosis (UTE): Surgical outcome and long-term follow-up. Fertil Steril 2010;94:856-61.  Back to cited text no. 19
Comiter CV. Endometriosis of the urinary tract. Urol Clin North Am 2002;29:625-35.  Back to cited text no. 20
Sánchez Merino JM, Guillán Maquieira C, García Alonso J. The treatment of bladder endometriosis. Spanish literature review. Arch Esp Urol 2005;58:189-94.  Back to cited text no. 21
Gustilo-Ashby AM, Paraiso MF. Treatment of urinary tract endometriosis. J Minim Invasive Gynecol 2006;13:559-65.  Back to cited text no. 22
Nezhat C, Nezhat F, Nezhat CH, Nasserbakht F, Rosati M, Seidman DS, et al. Urinary tract endometriosis treated by laparoscopy. Fertil Steril 1996;66:920-4.  Back to cited text no. 23
Donnez J, Nisolle M, Squifflet J. Ureteral endometriosis: A complication of rectovaginal endometriotic (adenomyotic) nodules. Fertil Steril 2002;77:32-7.  Back to cited text no. 24
Westney OL, Amundsen CL, McGuire EJ. Bladder endometriosis: Conservative management. J Urol 2000;163:1814-7.  Back to cited text no. 25
Coleman L, Overton C. GPs have key role in early diagnosis of endometriosis. Practitioner 2015;259:13-7, 2.  Back to cited text no. 26
Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: A review. Eur Radiol 2006;16:285-98.  Back to cited text no. 27
Chapron C, Dubuisson JB. Laparoscopic management of bladder endometriosis. Acta Obstet Gynecol Scand 1999;78:887-90.  Back to cited text no. 28
Sillou S, Poirée S, Millischer AE, Chapron C, Hélénon O. Urinary endometriosis: MR imaging appearance with surgical and histological correlations. Diagn Interv Imaging 2015;96:373-81.  Back to cited text no. 29
Langmade CF. Pelvic endometriosis and ureteral obstruction. Am J Obstet Gynecol 1975;122:463-9.  Back to cited text no. 30
Manyonda IT, Neale EJ, Flynn JT, Osborn DE. Obstructive uropathy from endometriosis after hysterectomy and oophorectomy; two case reports. Eur J Obstet Gynecol Reprod Biol 1989;31:195-8.  Back to cited text no. 31
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.  Back to cited text no. 32
Mahutte NG, Arici A. Medical management of endometriosis-associated pain. Obstet Gynecol Clin North Am 2003;30:133-50.  Back to cited text no. 33
Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M, et al. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005;12:508-13.  Back to cited text no. 34
Castaneda CV, Shapiro EY, Ahn JJ, Van Batavia JP, Silva MV, Tan Y, et al. Endoscopic management of intraluminal ureteral endometriosis. Urology 2013;82:307-12.  Back to cited text no. 35
Zanetta G, Webb MJ, Segura JW. Ureteral endometriosis diagnosed at ureteroscopy. Obstet Gynecol 1998;91:857-9.  Back to cited text no. 36
Lavelle KJ, Melman AW, Cleary RE. Ureteral obstruction owing to endometriosis: Reversal with synthetic progestin. J Urol 1976;116:665-6.  Back to cited text no. 37
Pittaway DE, Daniell JF, Maxson WS, Winfield AC, Wentz AC. Recurrence of ureteral obstruction caused by endometriosis after danazol therapy. Am J Obstet Gynecol 1982;143:720-2.  Back to cited text no. 38
Susini T, Massi D, Massi GB. Ureteral obstruction due to retroperitoneal endometriosis: A conservative approach including surgery and GnRH analogs. Gynecol Endocrinol 1996;10:129-31.  Back to cited text no. 39
Bohrer J, Chen CC, Falcone T. Persistent bilateral ureteral obstruction secondary to endometriosis despite treatment with an aromatase inhibitor. Fertil Steril 2008;90:2004.e7-9.  Back to cited text no. 40
Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013;28:1552-68.  Back to cited text no. 41
Vercellini P, Pisacreta A, Pesole A, Vicentini S, Stellato G, Crosignani PG, et al. Is ureteral endometriosis an asymmetric disease? BJOG 2000;107:559-61.  Back to cited text no. 42
Kulkarni RP, Bellamy EA. A new thermo-expandable shape-memory nickel-titanium alloy stent for the management of ureteric strictures. BJU Int 1999;83:755-9.  Back to cited text no. 43
Douglas C, Rotimi O. Extragenital endometriosis – A clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol 2004;24:804-8.  Back to cited text no. 44
Frenna V, Santos L, Ohana E, Bailey C, Wattiez A. Laparoscopic management of ureteral endometriosis: Our experience. J Minim Invasive Gynecol 2007;14:169-71.  Back to cited text no. 45
Nezhat C, Silfen S, Nezhat F, Martin D. Surgery for endometriosis. Curr Opin Obstet Gynecol 1991;3:385-93.  Back to cited text no. 46
Antonelli A, Simeone C, Canossi E, Zani D, Sacconi T, Minini G, et al. Surgical approach to urinary endometriosis: Experience on 28 cases. Arch Ital Urol Androl 2006;78:35-8.  Back to cited text no. 47
Ghezzi F, Cromi A, Bergamini V, Serati M, Sacco A, Mueller MD, et al. Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil Steril 2006;86:418-22.  Back to cited text no. 48
Marcelli F, Collinet P, Vinatier D, Robert Y, Triboulet JP, Biserte J, et al. Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management. Prog Urol 2006;16:588-93.  Back to cited text no. 49
Pérez-Utrilla Pérez M, Aguilera Bazán A, Alonso Dorrego JM, Hernández A, de Francisco MG, Martín Hernández M, et al. Urinary tract endometriosis: Clinical, diagnostic, and therapeutic aspects. Urology 2009;73:47-51.  Back to cited text no. 50
Schindler AE, Christensen B, Henkel A, Oettel M, Moore C. High-dose pilot study with the novel progestogen dienogestin patients with endometriosis. Gynecol Endocrinol 2006;22:9-17.  Back to cited text no. 51
Seracchioli R, Mabrouk M, Manuzzi L, Guerrini M, Villa G, Montanari G, et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J Minim Invasive Gynecol 2008;15:435-9.  Back to cited text no. 52
Bosev D, Nicoll LM, Bhagan L, Lemyre M, Payne CK, Gill H, et al. Laparoscopic management of ureteral endometriosis: The Stanford University hospital experience with 96 consecutive cases. J Urol 2009;182:2748-52.  Back to cited text no. 53
Berlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L, et al. Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv 2009;64:830-42.  Back to cited text no. 54
Nezhat C, Nezhat F, Green B. Laparoscopic treatment of obstructed ureter due to endometriosis by resection and ureteroureterostomy: A case report. J Urol 1992;148:865-8.  Back to cited text no. 55
Antonelli A, Simeone C, Zani D, Sacconi T, Minini G, Canossi E, et al. Clinical aspects and surgical treatment of urinary tract endometriosis: Our experience with 31 cases. Eur Urol 2006;49:1093-7.  Back to cited text no. 56
Nezhat C, Nezhat F, Nezhat C. Operative laparoscopy (minimally invasive surgery): State of the art. J Gynecol Surg 1992;8:111-41.  Back to cited text no. 57
Gran JT, Gaarder PI, Husby G, Thorsby E. IgG heavy chain (Gm) allotypes in rheumatoid arthritis and in healthy individuals seropositive for IgM-rheumatoid factor. Scand J Rheumatol 1985;14:144-8.  Back to cited text no. 58
Bondavalli C, Dall'Oglio B, Schiavon L, Luciano M, Guatelli S, Parma P, et al. Pathology of the gynecologic ureter: Our experience. Arch Ital Urol Androl 2002;74:25-6.  Back to cited text no. 59
Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N, et al. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril 2009;92:453-7.  Back to cited text no. 60
Seracchioli R, Mannini D, Colombo FM, Vianello F, Reggiani A, Venturoli S, et al. Cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis. J Endourol 2002;16:663-6.  Back to cited text no. 61
Streem SB, Franke JJ, Smith JA. Surgery of the ureter. In: Walsh PC, Retik AD, Vaughan ED Jr., editors. Campbell's Urology. 7th ed., Vol. 3. Philadelphia: WB Saunders; 2003. p. 2327.  Back to cited text no. 62
Shalhav AL, Elbahnasy AM, Bercowsky E, Kovacs G, Brewer A, Maxwell KL, et al. Laparoscopic replacement of urinary tract segments using biodegradable materials in a large-animal model. J Endourol 1999;13:241-4.  Back to cited text no. 63
Heidenreich A, Ozgur E, Becker T, Haupt G. Surgical management of vesicoureteral reflux in pediatric patients. World J Urol 2004;22:96-106.  Back to cited text no. 64
Veale JL, Yew J, Gjertson DW, Smith CV, Singer JS, Rosenthal JT, et al. Long-term comparative outcomes between 2 common ureteroneocystostomy techniques for renal transplantation. J Urol 2007;177:632-6.  Back to cited text no. 65
Gözen AS, Cresswell J, Canda AE, Ganta S, Rassweiler J, Teber D, et al. Laparoscopic ureteral reimplantation: Prospective evaluation of medium-term results and current developments. World J Urol 2010;28:221-6.  Back to cited text no. 66
Nezhat CH, Malik S, Nezhat F, Nezhat C. Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative endometriosis. JSLS 2004;8:3-7.  Back to cited text no. 67
Carmignani L, Ronchetti A, Amicarelli F, Vercellini P, Spinelli M, Fedele L, et al. Bladder psoas hitch in hydronephrosis due to pelvic endometriosis: Outcome of urodynamic parameters. Fertil Steril 2009;92:35-40.  Back to cited text no. 68
Riedmiller H, Becht E, Hertle L, Jacobi G, Hohenfellner R. Psoas-hitch ureteroneocystostomy: Experience with 181 cases. Eur Urol 1984;10:145-50.  Back to cited text no. 69
Ahn M, Loughlin KR. Psoas hitch ureteral reimplantation in adults – Analysis of a modified technique and timing of repair. Urology 2001;58:184-7.  Back to cited text no. 70
Benson MC, Ring KS, Olsson CA. Ureteral reconstruction and bypass: Experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation. J Urol 1990;143:20-3.  Back to cited text no. 71
Harrow BR. A neglected maneuver for ureterovesical reimplantation following injury at gynecologic operations. J Urol 1968;100:280-4.  Back to cited text no. 72
Mathews R, Marshall FF. Versatility of the adult psoas hitch ureteral reimplantation. J Urol 1997;158:2078-82.  Back to cited text no. 73
Rassweiler JJ, Gözen AS, Erdogru T, Sugiono M, Teber D. Ureteral reimplantation for management of ureteral strictures: A retrospective comparison of laparoscopic and open techniques. Eur Urol 2007;51:512-22.  Back to cited text no. 74
Klein RS, Cattolica EV. Ureteral endometriosis. Urology 1979;13:477-82.  Back to cited text no. 75


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