雷射激光治療輸尿管子宮內膜異位症導致之阻塞性腎水腫 - 病例報告

王毓婷¹、鄒凱亦¹

¹台北醫學大學附設雙和醫院 泌尿科

Laser ablation of ureteral endometriosis complicated with obstructive uropathy : case report

Yu-Ting Wang^1, Kai-Yi Tzou¹

¹Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City

Introduction

Ureteral endometriosis is a rare condition, but it could cause significant loss of renal function if the appropriate treatment is not delivered promptly. Surgery is indicated for the circumstances of obstructive uropathy; however, the studies comparing outcomes between different surgical methods is limited. We hence described a case of right distal ureteral endometriosis with subsequent laser ablation of the lesion. Through this case report and literature review, we aimed to evaluate the efficacy and safety of laser ablation in treating ureteral endometriosis.

Case report

A 47-year-old female patient had the medical history of right endometrioma, s/p laparoscopic right oophorocystectomy in 2013. This time, a health checkup revealed elevated creatinine level, but she denied to notice fever, flank pain, decreased urine output, dysuria, nor hematuria. She first sought help at our nephrology outpatient clinic, where A+P CT found grade IV right hydronephrosis with an intrinsic mass lesion about 1cm in size at the right distal ureter, so she was further referred to our urology department. Ureteroscopic biopsy was arranged promptly to rule out urological malignancy; the pathology report nevertheless suggested endometriosis. Under the impression of intrinsic right ureteral endometriosis, she was admitted for laser ablation of the lesion. Under general anesthesia, the patient underwent visually complete ablation of the lesion via ureteroscopy, and right double J stent was inserted in the end. The patient tolerated the procedure well. She was discharged on postoperative day 2 as no postoperative complications were observed. Follow-up sonogram and laboratory data found resolution of right hydronephrosis and acute kidney injury.

Discussion

Ureteral endometriosis that typically lacks specific symptomatology could silently compromise renal function and lead to severe morbidity. Related obstructive uropathy calls for timely surgical intervention. Despite no solid consensus, the choice of suitable surgical technique is generally based on the type of ureteral endometriosis (intrinsic vs. extrinsic) and the location and extent of the disease. Overall, ureterolysis is reserved for extrinsic lesions, whereas intrinsic lesions, lesions > 3cm, or lesions situated below the level of iliac vessels are candidates for ureteral resection and reconstruction. Nevertheless, the recurrence rate associated with these aforementioned techniques are high, and these procedures are burdened by the additionally increased risks of ureteral trauma, infection, urinary leakage, and future anastomotic stricture. This case demonstrated the short-term efficacy and safety of ureteroscopic laser ablation for managing intrinsic ureteral endometriosis.  Importantly, long-term follow-up of the patient will be necessary to testify the durability of its therapeutic effect.