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Urological surgery
of endometriosis

Treatment of urologic endometriosis

Deep endometriosiscan infiltrate the organs of the urinary tract, including the bladder and ureters.

General information on urological endometriosis

When endometriosis affects the bladder, this generally leads to urinary pain during menstruation or the need to urinate frequently including at night.

Damage to the ureters is generally silent. The narrowing of the lumen of the ureter leads to an accumulation of urine upstream, with gradual dilation of the basin of the kidney, sometimes leading to atrophy of the kidney. The consequences can be serious, because by the time diagnosis occurs the kidney be working poorly or not at all.

Sometimes renal colic may reveal the diagnosis and require emergency urine diversion because of the intense pain.

Surgery for endometriosis nodules of the bladder

Surgery for bladder endometriosis is usually performed by the gynecologic surgeon and involves nodule removal.

In the case of very large lesions, surgery can be performed by a combined route: the urological surgeon performs cystoscopy while the gynecological surgeon performs laparoscopy.

The bladder is opened and then sutured. This requires wearing a bladder catheter for at least 7 days to allow healing to the bladder. A retrograde cystography is performed before catheter removal to ensure complete healing of the bladder.

Our team performs between 20 and 25 bladder endometriosis procedures per year.

Surgery of the ureters

Surgery of the ureters can be performed by :

  • ureterolysis: the nodule is removed, which allows decompression of the ureter without cutting it (70% of cases)
  • resection of the stenotic or infiltrated part: the severed ureter can either be repaired by 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 and then removed at the consultation with the urological surgeon.

Our team performs between 20 and 25 ureteral stenosis procedures each year.

Endométriose urologique schéma
Fig3 : illustration of the evolution of a ureter nodule with progressive dilation of the organs upstream of the nodule

Consequence of endometriosis of the ureters: renal atrophy

Before deciding on the most appropriate procedure for the ureter and in the case of major dilation of the kidney, a renal scan may be proposed to ensure continued satisfactory renal function. f the contribution of the atrophied kidney is less than 10% of global renal function, we do not propose ureteral reimplantation, if less than 5%, we propose a nephrectomy.

Our team performs between 3 and 5 nephrectomies per year.

in numbers


surgeries for bladder endometriosis per year at IFEM ENDO


surgeries for ureteral stenosis per year at IFEM ENDO


nephrectomies per year at IFEM ENDO


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 support and advice from a urological endometriosis specialist

IFEM Endo, a center specializing in the management of endometriosis and complex forms of the disease, is here to accompany you on your urological endometriosis care journey.

Last updated on May 4, 2021 @ 10:01