(MP4-3) Robotic-assisted ureteroureterostomy/ureteroneocystostomy for the treatment of intrinsic ureteral endometriosis related obstructive uropathy – a preliminary experience of a single academic center
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  • 2015-11-30,
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機械手臂輔助輸尿管重接手術治療內生型輸尿管子宮內膜異位症導致之阻塞性腎水腫 – 單一醫學中心之初步報告
陳威任1、黃逸修1, 3, 5、陳怡仁2, 4、林登龍1, 3, 5、陳光國1, 3, 5
1臺北榮民總醫院泌尿部,2婦女醫學部;3國立陽明大學醫學系泌尿學科,4婦產學科;5書田泌尿科學研究中心
Robotic-assisted ureteroureterostomy/ureteroneocystostomy for the treatment of intrinsic ureteral endometriosis related obstructive uropathy – a preliminary experience of a single academic center
Wei-Jen Chen1, Eric Yi-Hsiu Huang 1, 3, 5, Yi-Jen Chen 2, 4, Alex T. L. Lin1, 3, 5, Kuang-Kuo Chen1, 3, 5
Department of Urology1, Department of Obstetrics and Gynecology2, Taipei Veterans General Hospital; Department of Urology3, Department of Obstetrics and Gynecology4, School of Medicine, National Yang-Ming University; Shu-Tien Urological Science Research Center5
 
Purpose:
Endometriosis occurred in 10-15% of women of childbearing age. Ureteral involvement is a rare manifestation of endometriosis and occurs in only about 0.1% of women. The diagnosis is challenging since up to 50% of patients are asymptomatic and may cause silent kidney or progressive renal function loss. There is no high evidence based treatment protocol available currently. Literature is limited in case series and laparoscopic resection of the endometriosis tissue seems to be the preferred management now. Robotic-assisted management of ureteral endometriosis is a viable option but was scarcely reported. We reported 4 cases of ureteral endometriosis with severe obstructive uropathy successful treated by robotic-assisted segmental resection and ureteroureterostomy or ureteroneocystostomy (RUU or RUC).
Materials and Methods:
From January 2013 to September 2015, 3 women received RUU and 1 woman received RUC due to ureteral endometriosis related obstructive uropathy were reviewed.
Results
Mean age was 36.25 year old (range 29-48), with mean follow-up time 12.5 months (range 3-32). One patient was incidentally found to have hydronephrosis, and 3 patients were initially presented with ipsilateral flank pain. All patients had normal serum creatinine (range 0.62-0.97mg/dl) preoperatively  . Diagnosis was proved by MRI imaging. The mean time of hydronephrosis to definitive treatment was 29.25 months (range 2-75). Left lower third ureter was involved in 3 patients, right lower third ureter was involved in 1 patients. All 4 patients had previous treatment failure by double-J stenting with or without medical treatment. Pre-op ureteroscopy had been performed in all 4 patients, but only 1 patient had endometriosis tissue invasion confirmed by ureteroscopic biopsy. Double-J stenting was performed for all the patients intraoperatively and was removed 4-6 weeks after the operation. The proximal and distal ureter cut ends were examined by frozen section during the operation to ensure free of endometriosis tissue. Permanent pathology reports all confirmed endometrial glands in the ureteral wall. One patient received myomectomy together, and another patient received hysterectomy and left oopherectomy simultaneously. The mean blood loss was 132.5cc (range 30-250). No complication occurred. All patient received diphereline treatment for 6 months after the operation. Follow-up sonography at post-op 3 months all showed resolves of hydronephrosis. Two patients with follow-up of more than one year were free of hydronephrosis.
Conclusion:
Our experiences proved the feasibility and efficacy of robotic-assisted approach in this rare situation. The preliminary results seemed promising and prospective patient enrollment is undergoing.
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    2015-11-30 13:45:00
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