Endometriosis of the urinary tract is predominatly found in the bladder (70-80%). The ureter could be involved (15-20%) of the urinary case. Left side is more often affected, which may be because the sigmoid colon prevent regurgitated endometrial cells to be cleared by peritoneal fluid on the left side.1,2,3,4 Urinary tract endometriosis occurs in 1 % of women pelvic endometriosis and gold standard diagnosis is laparoscopy and biopsy with hystological confirmation.2,3,4,5 Investigative procedures play a key role in diagnosis ureteral endometriosis. Abdominal sonogrpahy and CT scan were suggestive hydronephrosis secondary due to obstructive which the most common was presented stone or stricture. If there were a suggestive mass it could be diagnose as endometriosis or malignancy.5 Case
A 47 years old woman, P3, present with Abdominal pain on left quadran due to Left Hydroureter due Deep Infiltrating Endometriosis in Ureter with Adenomyosis. Patient complain of abdominal pain since 8 months before admission. Abdominal pain was cyclic pain correspond to menstrual pain. Patien already performed physical and MRI found there was endometriosis lession on the left distal part of ureter causing Left Hydroureter. Patient prior to operation was already performed left nephrostomy to ensure the function of left kidney and the result within normal limit. Operation was done and found there was a stricture at distal part of ureter and no sign of deep infiltrating endometriosis. Patient was found adenomyoisis at performed total hysterectomy. On exploration found enlargement of the left ureter, found no endometriosis lession but there was ureter stricture. Performed ureter resection and the specimen sent to hystopathology. Ureter was repaired and performed reimplantation to vesica.
Deep infiltrating endometriosis in ureter was a rare case. Diagonosis were made from preopersative but need to confirm intraoperatively. Gold standard is still Hystopathology. Differential diagnosis between endometrial lession with ureter stricture is one of the thing that need further studies. Preoperative diagnosis from physical examination and MRI found there still discrepancies between preopertive and intraoperative findings.
Hydroureter ; Surgical ; Deep Infiltrating Endometriosis ; Ureter Stricture