Dr. Meenakshi Sundaram is a Consultant Gynaecological Endoscopic and Robotic Surgeon at Apollo Hospital, Chennai. She attained Diploma in Advanced Endoscopy, Beams Hospital, Mumbai; Diploma in Advanced Endoscopy, Kiel, Germany and Robotic Surgery Training, Florida, U.S.A. She is a Managing Committee member, Indian Association of Gynaecological Endoscopists (IAGE). She has conducted live workshops in various cities and has been faculty in National & International Conferences and has authored several publications in International & National Journals and chapters in various books.
Ureteral endometriosis is asymptomatic in as many as 50% of patients. Because of nonspecific symptoms and nonspecific imaging findings, incorrect diagnosis of ureteral endometriosis can lead to obstructive uropathy and renal damage.
A 32 year P2L2 woman with history of left flank pain. Despite several evaluations by physicians, including gynaecologists, the cause of her symptoms was not diagnosed. Left ureteral endometriosis was suspected (Fig. 1). Laparoscopic distal ureterectomy with neocystostomy (Figs. 2, 3, 4) and double-J ureteral stent insertion were performed and the same removed after 3 months. Surgery is necessary in patients with ureteral endometriosis who have persistent symptoms and/or hydroureteronephrosis or impaired renal function. The main goals of surgery are preservation of renal function, relief of obstruction, and prevention of recurrence.
Therefore, physicians should suspect ureteral endometriosis in reproductive-age women with unilateral or bilateral distal ureteral obstruction and/or hydroureteronephrosis in the absence of urolithiasis. A high index of suspicion and the use of imaging modalities enable earlier diagnosis and preservation of renal function.
Conflict of interest Meenakshi Sundaram, Rachita Munjal and Juhul Patel declare that they have no conflict of interest.
Informed Consent Informed consent was obtained from the participant in this study.
Financial disclosure None declared.
