Intrinsic unilateral ureteral endometriosis: A rare case report

Saad Alenezi 1, Mohammad Zaheer 2, Salah Khudair 3

Affiliations

03 January 2023

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doi: 10.1016/j.ijscr.2023.107966

Abstract

Introduction and importance: Ureteral endometriosis is a rare disease and it has variable and subtle clinical presentation and often it lead to delayed diagnosis and worse outcome.

Case presentation: Here we present a 44-year-old married lady who presented with dull aching right iliac fossa pain. CT urography right moderate hydro-uretero nephrosis with a suspicion of a mass in the lower right ureter. Diagnostic rigid ureteroscopy showed completely intraluminal polypoidal pedunculated right lower ureteral mass with near total occlusion of the lumen, which was excised completely by Ho: Yag laser. Histopathology confirmed pure endometriosis tissue with no ureteral tissue. Follow up showed no recurrence of the mass, however eventually the patient developed deterioration in kidney function due to the long-standing undiscovered obstruction.

Clinical discussion: Ureteral endometriosis can cause silent obstruction for a long time. Surgical intervention has different modalities according to the type of U.E, and it is the appropriate treatment method for U.E causing complete obstruction to preserve kidney function.

Conclusion: Ureteral endometriosis is a rare but should be included in the differential diagnosis of premenopausal women with ureteral obstruction of unknown cause. Early intervention is critical for better outcomes.

Keywords: Case report; Endometriosis; Intrinsic ureteral endometriosis; Laser; Unilateral urinary obstruction; Ureteric obstruction.

Conflict of interest statement

Declaration of competing interest There is no conflict of interest including any financial or personal relationships with other people or organisations or any work influencers.

Figures

Fig. 1 a: Computed constructed image showing filling defect and right hydronephrosis. b: Axial CT urography showing right hydronephrosis.

Fig. 1 a: Computed constructed image showing filling defect and right hydronephrosis. b: Axial CT urography showing right hydronephrosis.

Fig. 2 a: Intra op findings: ureteroscopy showing a rounded mass attached to the ureter wall. b: Intra op findings: ureteroscopy showing a rounded mass attached to the ureter wall.

Fig. 2 a: Intra op findings: ureteroscopy showing a rounded mass attached to the ureter wall. b: Intra op findings: ureteroscopy showing a rounded mass attached to the ureter wall.

Fig. 3 a: Histopathology showing pure endometrial tissue. b: Histopathology showing pure endometrial tissue.

Fig. 3 a: Histopathology showing pure endometrial tissue. b: Histopathology showing pure endometrial tissue.

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