URINARY-TRACT ENDOMETRIOSIS TREATED BY LAPAROSCOPY

Objective: To evaluate the efficacy of the laparoscopic approach for t he diagnosis and treatment of severe urinary tract endometriosis. Desi gn: Retrospective review of 28 cases of severe urinary tract endometri osis. Setting: Center for Special Pelvic Surgery, a tertiary referral center. Patient(s): Between October 1989 and September 1994, we treate d 28 women mho had deeply infiltrating urinary tract endometriosis (bl adder, 7, ureter, 21). Intervention(s): All procedures were performed laparoscopically. Main Outcome Measure(s): Postoperative urinary funct ion, pain relief, and complications. Result(s): Those who had vesical endometriosis underwent partial cystectomy and primary repair. Partial ureteral obstruction was found in 17 women; 10 underwent ureterolysis and excision of endometriosis, and 7 had partial wall resect ion. Fou r patients with ureter involvement had complete obstruction. Three und er went partial resection and ureteroureterostomy, and one had uretero neocystostomy. The rate of ureteral endometriosis in the present serie s is higher than that reported previously. Conclusion(s): Severe infil trative endometriosis of the bladder and the ureter can present withou t specific symptoms and can cause silent compromise of renal function. We demonstrated that the laparoscopic approach is safe and effective in the diagnosis and treatment of this entity.