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MP23-12: Endometriosis – urinary tract involvement and predictive factors for major surgery

Saturday, May 13
7:00 AM - 9:00 AM
Location: BCEC: Room 151

Presentation Authors: Maria José Freire*, Paulo Jorge Dinis, Rita Medeiros, Luís Sousa, Fernanda Águas, Arnaldo Figueiredo, Coimbra, Portugal

Introduction: Endometriosis affects 5-15% of premenopausal females. Urinary tract endometriosis (UTE) is present in about 1- 2% of all women with endometriosis.
Objective: To assess the severity and surgical treatment of deep infiltrating endometriosis (DIE) with involvement of the urinary tract (UT) as well as the existence of predictive factors for major surgery in patients with UTE.


Methods: Retrospective analysis of 656 women undergoing surgery for endometriosis, between January 2005 and August 2016, in a large academic centre. The authors identified a group of 28 (4.3%) patients, with a mean age of 38 ± 6.9 years (27-50) at diagnosis, who underwent minor surgery (percutaneous nephrostomy [PCN] or any kind of endoscopic surgery) or major surgery (open or laparoscopic procedures) for UTE. Mode of presentation, surgeries performed, post-operative data and complication rates were analysed.

Results: Only 4 patients (14.3%) were asymptomatic and the most frequent symptom was lumbar pain (n = 14, 50%). The mean lesions size was 2.8 ± 1.7 cm (0.5-5) and affected the ureter in 13 (46.4%), the bladder in 11 (39.3%) and both structures in 4 (14.3%) patients. The left ureter was the most involved (n=10, 35.7%). Hydronephrosis was detected in 18 (64.3%) patients and 12 (42.9%) had renal function impairment (7 [25%] had partial loss, and 5 [17.9%] total loss of renal function). Patients with ureteric involvement were more likely to lose renal function (p = 0.034). Concerning minor surgeries, 12 (42.9%) patients underwent TURB, 9 (32.1%) double-J stenting or PCN, and 4 (14.3%) ureteroscopy. The major surgeries were distal ureterectomy in 9 (32.1%), nephrectomy in 3 (10.7%) and excision of endometriomas by laparotomy/laparoscopy in 4 (14.3%) cases. Each patient had in average 1.79 ± 1.3 (1-6) surgeries, and 11 (39.3%) had more than one surgery. The total hospitalization time was 6.3 ± 7.4 days (1-32). Patients with ureteric involvement underwent major surgeries more often (p = 0.025) and had longer hospital stay (8.2 vs 3.1 days, p = 0.05). With a mean follow-up of 36.3 months, no patient with bladder involvement had recurrence, 3 (10.7%) showed ureteral re-estenosis (Clavien-Dindo grade IIIb), 1 (3.6%) remained with lumbar pain and 1 (3.6%) had double-J stent calcification.

Conclusions: Despite being a histologically benign pathology, DIE can have serious consequences in the UT, often leading to multiple procedures and may result in total loss of kidney function. Surgery is highly successful in most cases and patients with ureteric involvement are more likely to undergo major surgery and have longer hospitalization.

Source Of Funding: none

Maria José Freire, Master in Medicine

Coimbra Hospital and University Centre

Dr. Maria José Freire, Master in Medicine by Abel Salazar Institute of Biomedical Sciences, University of Porto, Portugal, is currently the Chief-Resident of the Urology and Renal Transplantation Department of the Coimbra Hospital and University Centre. She is also the Scientific Meeting Coordinator of the Portuguese Urology Residents Executive Committee.

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