泌尿系統的子宮內膜異位症: 病例報告及文獻回顧
何宣瑩 洪順興 劉建良 王致丞 沈坤宏
奇美醫學中心 外科部 泌尿外科
Urinary tract endometriosis: Case report and review of literature
Hsuan-Ying Ho, Shun-Hsing Hung, Chien-Liang Liu, Jhih-Cheng Wang, Kun-Hung Shen
Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan
Case report:
Endometriosis is defined as endometrial glands and stroma at extrauterine sites. Most commonly, it affects organs like ovaries, uterine ligaments, fallopian tubes, rectum and cervico-vaginal regions, but involvement of the urinary tract is rare (1–2%). Urinary tract endometriosis refers to endometriotic implants of the bladder, ureter, kidney, and urethra. In women with urinary tract endometriosis, the bladder and ureter are most commonly affected. We report our experience of 3 patients of urinary tract endometriosis.
Case 1 and 2 both has endometriosis in ureter. Case 1 has an initial presentation of left flank dull pain, and she has a history of entometrial polyps within uterine. Urotract image including IVP and abdominal CT show Left hydronephrosis and redundant, tortuous left ureter with moderate dilatation and suspicious filling defect. Left URS was performed, finding uterine myoma compression to bladder, and a nodular tumor at left middle ureter. Endoscopic biopsy was done, and the pathology report result in endometriosis. The patien eventually received laser vaporization for endometriosis via ureteroscopy. Case 2 has similar history, and received Robotic assisted laparoscopic segmental resection and ureteroureterostomy.
Case 3 has urinary bladder endometriosis. She has urinary frequency and discomfort with urination during her menstrual peroid for 6 months. At gynecology OPD, transvaginal ultrasonography revealed bladder tumor. Abdominal CT revealed: Enhanced mass in urinary bladder dome with perivesical infiltraitons, abutting to uterus. TUR-BT was performed, and a 2.5cm pseudo-papillary lesion over posterior wall was resected. The pathologist confirmed the diagnosis of endometriosis, and the patient was referred to gynecologist for medical treatment.