Parametrial Endometriosis: End-to-End Ureteral Laparoscopic Anastomosis

Abstract

Study Objective

The aim of this study is to present a clinical case of a patient with parametrial endometriosis and ureteral involvement.

Design

This is a clinical case study that focuses on the detailed description of a patient with parametrial endometriosis and ureteral involvement.

Setting

Laparoscopic surgery was performed using a 3D camera with 0° optics. The patient was positioned in low lithotomy, and four accessory trocars were placed laterally. Use of bipolar and ultrasonic energy.

Patients or Participants

A 29-year-old woman with no significant medical history and no previous pregnancies presented with dyspareunia and lumbosacral pain lasting four months. An abdominal ultrasound revealed left pelvicalyceal dilation and an adnexal mass consistent with a 4 cm endometrioma. Her kidney function remained normal. A pelvic examination showed specific tenderness at the left parametrial region extending to the pelvic wall. A pelvic MRI was conducted, which reported a hypointense lesion at the left adnexal level measuring approximately 4 cm, along with an irregular fibrotic-appearing lesion associated with ureteral dilation.

Interventions

Laparoscopic surgery was performed. The parametrial nodule was completely resected while preserving surrounding anatomical structures, and a left end-to-end ureteral anastomosis was performed, accompanied by the placement of a pigtail catheter.

Measurements and Primary Results

A six-month follow-up MRI revealed a lesion-free parametrial area and a normally sized ureter.

Conclusion

The prevalence of ureteral endometriosis is approximately 1% and is strongly associated with parametrial involvement. MRI is highly accurate in detecting ureteral endometriosis and should be performed after suspicious ultrasound findings. Surgical treatment is the first-line approach in cases of ureteral obstruction, and laparoscopic end-to-end anastomosis is a viable option when the injury is located far from the vesicoureteral junction.