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Laparoscopic Treatment of Ureteral Endometriosis with and without Robotic Assistance

Rebecca Falik, MD

Product Details
Product ID: ACS-5617
Year Produced: 2018
Length: 8 min.
Contact Us: 1-800-253-7657

The most common sites of urinary tract endometriosis are the bladder, ureter, and kidneys. Ureteral endometriosis can be difficult to diagnose, as it is asymptomatic in over 50% of patients. This can be dangerous as it can cause silent kidney loss if it results in ureteral stricture and obstruction. Ureteral endometriosis can be divided into extrinsic or intrinsic disease. Extrinsic, or superficial disease, is 4-5 times more common than intrinsic disease. It is caused by superficial endometriosis of the serosa of the ureter that compresses the ureter from fibrosis of the overlying peritoneum. Intrinsic disease invades deeply into the ureteral wall, muscularis, or mucosa, and requires pathologic confirmation. It is more commonly symptomatic, but still less than 15% of patients will present with cyclic hematuria. Laparoscopic treatment of endometriosis with complete excision of fibrotic and endometriotic lesions is the treatment of choice. Laparoscopy offers numerous advantages over laparotomy, in particular improved visualization and magnification of endometriotic lesions, less blood loss, and less adhesion formation. Laparoscopic ureterolysis has been shown to be successful in 90% of the cases of hydroureter caused by ureteric endometriosis. For intrinsic disease, ureteral resection is indicated. If the lesion is located in the lower third of the ureter, close to the bladder, a ureteroneocystotomy with or without Psoas hitch may be performed. A larger distance may require a Boari flap, ileal interposition, or autotransplantation. Lesions in the middle or upper third of the ureter may require a ureteroureteral anastomosis.