Endometriosis
in figures
20-25
bladder endometriosis operations / year at ifem endo
20-25
operations for ureteral stenosis / year at FEM Endo
2-5
nephrectomies / year at FEM Endo
Urological surgery
endometriosis
Management of urological endometriosis
Deep endometriosis can infiltrate the organs of the urinary tract, notably the bladder and ureters.
General information on urological endometriosis
Involvement of the bladder generally causes urinary pain during menstruation, or the need to urinate frequently, including at night.
Damage to the ureters is generally silent. Narrowing of the ureter lumen leads to an accumulation of urine upstream, with dilatation of the progressive renal pelvis, sometimes progressing to renal atrophy. The consequences can be serious, as at the time of diagnosis the kidney may be little or non-functional.
Sometimes, an inaugural renal colic may reveal the diagnosis, necessitating an emergency urine diversion because of the intense pain.
Surgery for endometriosis nodules of the bladder
Surgery for bladder endometriosis is generally performed by a gynaecological surgeon, and involves removal of the nodule.
In the case of very large lesions, surgery can be performed using a combined approach: the urological surgeon performs cystoscopy, while the gynaecological surgeon performs laparoscopy.
The bladder is opened, then sutured, requiring a bladder catheter to be worn for at least 7 days to allow healing on a resting bladder. Retrograde cystography is performed prior to catheter removal, to ensure complete bladder healing.
Our team performs between 20 and 25 bladder endometriosis procedures per year.
Ureter surgery
Ureter surgery can be performed by :
- ureterolysis : the nodule is removed, allowing decompression of the ureter without cutting it (70% of cases).
- resection of the stenotic or infiltrated part: the severed ureter can either be repaired with an end-to-end suture, or re-implanted in the bladder. The latter procedure is performed by a urological surgeon.
A JJ catheter is kept in place for one month after surgery, then removed in consultation with the urological surgeon.
Our team performs between 20 and 25 ureteral stenosis procedures each year.
Consequence of endometriosis of the ureters: renal atrophy
Before deciding on the most appropriate ureteral procedure, and in cases of major renal dilatation, a renal scan may be proposed to ensure that satisfactory renal function is maintained. If the contribution of the atrophied kidney represents less than 10% of overall renal function, we do not propose ureteral reimplantation. If the contribution of the kidney is less than 5%, we propose nephrectomy.
Our team performs between 3 and 5 nephrectomies a year.
Endometriosis
Bibliography
Millochau JC, Roman H et al. J Gynecol Obstet Hum Reprod. 2017 Nov;46(9):691-692.
Darwish B, Roman H et al. J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):998-1006.
Roman H, et al. J Minim Invasive Gynecol. 2014 Nov-Dec;21(6):978-9.
Rozsnyai F, Roman H, et al. JSLS. 2011 Oct-Dec;15(4):439-47.
Get help from a urological endometriosis specialist
IFEM Endo, a center specializing in the management of endometriosis and complex forms of the disease, is there to support you throughout your urological endometriosis treatment.
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