The most common gynecologic disease associated with chronic pelvic pain is endometriosis. Endometriosis is the presence of uterine lining tissues endometrium growing outside the confines of the uterus. The ureters carry urine from the kidneys to the urinary bladder where urine is stored. The kidneys are located above the pelvis and the portion of the ureter that lies above the pelvic area is rarely affected by endometriosis. However, the portion of the ureter that lies below the pelvic area and the urinary bladder can be affected by endometriosis in a small percentage of patients.
The symptoms are variable for every woman but often include one or more of the following: urinary frequency and urgency, blood in the urine, pelvic pain and, possible flank pain and/or pain in the lower side of the back. In rare cases, patients have no symptoms but their ureter may become completely closed over time which can result in loss of function of that kidney. A pelvic ultrasound may help in the diagnosis, but a more accurate way to diagnosis urinary tract endometriosis is by a CT scan or an MRI urogram. The images help the doctor see the ureter and the urinary bladder and look for deformation of shape suggestive of endometriosis. A high index of suspicion should alert the urologist to fully evaluate the entire urinary tract when presented with a young female with a history of chronic pain and abnormalities seen on either ultrasound or CT scan.
Ultimately, renal preservation is the goal of any therapy. Medical therapy is usually not very helpful in treating endometriosis of the urinary tract. Unblocking a ureter with the stent is a temporary solution. More definitive surgical care may include removal of the affected portion of the ureter that has been scarred-in due to endometriosis and reanastomosis of the ureter. Most commonly, though, it will require a ureteral reimplantation to literally bypass the scarred, strictured area in an attempt to improve drainage and preservation of that renal unit. The symptoms of endometriosis can differ greatly from one woman to the next and, therefore, it is imperative that the urologist have a high index of suspicion when evaluating a patient with any of the constellation of symptoms.
Urinary tract endometriosis/ureteral strictures caused by endometriosis gynecology, urogynecology, minimally invasive gynecology, anesthesiology, urology, and nephrology.