Surgical expertise and outcomes of urinary tract endometriosis

Retrospective analysis of data on women undergoing surgery for urinary tract endometriosis sheds new light on the role that the surgical team’s expertise has on patient outcome. The findings, by French investigators, were published in The Journal of Minimally Invasive Gynecology.

For the study, the authors reviewed data on surgeries performed from July 2009 to December 2015 at a university tertiary referral center on 81 patients. Thirty-nine of the women had bladder endometriosis, 31 had ureteral endometriosis, and 11 had endometriosis in both those organs. In total, outcomes of 50 different ureteral procedures were analyzed because of bilateral ureteral localizations.

Full-thickness nodule excision or excision of the bladder wall without opening the bladder was performed on 50 women who had deeply infiltrating endometriosis. In 78% percent of the ureteral lesions, ureterolysis was performed and primary segmental resection was done for 22% of cases with ureteral involvement. No nephrectomy was required. In more than half the cases (54.5%), histology revealed ureteral endometriosis.

The investigators found that of the women who had surgery for ureteral nodules, 16% experience a Clavien-Dindo grade 3 complication, versus 8% who had surgery for bladder endometriosis. Overall, delayed postoperative outcomes related to urinary symptoms and fertility were favorable. Follow-up in the study ranged from 12 months to 7 years post-surgery and no recurrences were recorded.

The authors concluded that outcomes of surgery for urinary tract endometriosis generally are satisfactory but risk of postoperative complications need to be considered. They also recommended that the procedures be managed by an experienced multidisciplinary team.