INTRODUCTION: 44 yo G0, h/o dysmenorrhea, left pelvic pain, left back, leg pain with sitting, urgency and diarrhea. PMH:Nephrolithiasis. PSH: LSC LSO and lysis of adhesions. USG/ MRI/ CT Urogram: arcuate uterus, R adnexal endometrioma. Fibrotic deep pelvic endometriosis. Adhesions to sigmoid colon and urinary bladder. L ureteral narrowing possibly from an endometriotic implant.

METHOD: Severe adhesions, endometriosis of rectum, rectovaginal septum, pelvic sidewall, uterosacral ligament, cardinal ligament and serosa of the ureters are noted. CO₂ laser is used to lyse the tissues. ureters were identified. Using the shaving technique, the superficial endometriosis around the ureters and recto-sigmoid colon were excised. The suction irrigator is used for both blunt and sharp dissection and to protect the ureter during the excision. During the lysis of the bowel adhesions to the posterior wall of the uterus, a left ovarian remnant filled with chocolate fluid was noted, externally compressing the ureter, inferior hypogastric and obturator nerve causing hydroureter, back and leg pain on the left side. The round ligaments are desiccated. Using reverse vesico-uterine fold dissection technique, the bladder flap was developed. After colpotomy, the vaginal cuff is closed in two continuous layers with 2-0 vicryl barbed suture incorporating at least 1.5 cm of the cuff edge.

CONCLUSION:Ovarian remnants can compress the ureters. Shaving technique is useful in superficial ureter and bowel endometriosis excision. Post-operatively, patient reported significant back and leg pain relief.