EP24.32: Silent kidney loss associated with deep infiltrating endometriosis

Ureteral endometriosis is estimated to occur in about 0.08–1% of patients with endometriosis. That serious condition, may lead silently to obstruction of the urinary tract leading to hydronephrosis, hydroureter and potential loss of kidney function. Ureteral endometriosis is often associated with endometriomas, deeply infiltrating endometriosis, and the involvement of uterosacral ligaments. Diagnosis is often challenging due to the silent nature of the disease and the presence of non-specific or no symptoms. A 30 years old healthy woman was admitted to Tel Aviv Sourasky Medical Center ER due to abdominal pain lasting for 5 days without fever. She complained of dysmenorrhea but no other gynecological, urinary or digestive symptoms. Tran vaginal+abdominal US-left ovarian unilocular cyst 85*83*123mm with “ground glass” content, suspected for endometrioma. Severe hydronephrosis of left kidney with dilated calyx and cortical thinning, pelvic tubular structure 30*18 with clear fluid suspected for dilated left hydroureter. Under imaging limitations there were no signs of DIE CT UROGRAPHY confirmed the urinary system findings. LAB- creatinine 0.79, normal electrolytes. Surgery (laparoscopy) drainage of 10cm left endometrioma, left salpingectomy due to LT hydrosalpinx, removal of 4cm deep infiltrating endometriotic nodule that involved the left ureter, left uterine artery and left infundibulo-pelvic ligament. Left nephroureterectomy. In conclusion, non-specific symptoms and incorrect diagnosis of ureteral endometriosis can lead to renal damage as a result of prolonged hydronephrosis. Therefore, in routine targeted us scan for endometriosis, imaging of the kidneys must be an integral part. Physicians should suspect ureteral endometriosis in reproductive age women with unilateral or bilateral distal ureteral obstruction of uncertain cause. A high index of suspicion and use of imaging modalities enable earlier diagnosis, preservation of renal function, and improved prognosis.