Urinary tract endometriosis treated by laparoscopy

Objective: To evaluate the efficacy of the laparoscopic approach for the diagnosis and treatment of severe urinary tract endometriosis. Design: Retrospective review of 28 cases of severe urinary tract endometriosis. Setting: Center for Special Pelvic Surgery, a tertiary referral center. Patient(s): Between October 1989 and September 1994, we treated 28 women who had deeply infiltrating urinary tract endometriosis (bladder, 7, ureter, 21). Intervention(s): All procedures were performed laparoscopically. Main Outcome Measure(s): Postoperative urinary function, pain relief, and complications. Result(s): Those who had vesical endometriosis underwent partial cystectomy and primary repair. Partial ureteral obstruction was found in 17 women; 10 underwent ureterolysis and excision of endometriosis, and 7 had partial wall resection. Four patients with ureter involvement had complete obstruction. Three underwent partial resection and ureteroureterostomy, and one had ureteroneocystostomy. The rate of ureteral endometriosis in the present series is higher than that reported previously. Conclusion(s): Severe infiltrative endometriosis of the bladder and the ureter can present without specific symptoms and can cause silent compromise of renal function. We demonstrated that the laparoscopic approach is safe and effective in the diagnosis and treatment of this entity.