Ureteral Endometriosis Presenting as Recurrent Hydronephrosis: A Case Report

Omar Al Ayoubi,1 Mohammad Alaa Aldakak,1 Grace Tannous,1 Aiham Mhimid,2 Mohamad Abdou Awad,2 Louai Alia2 1Faculty of Medicine, Damascus University, Damascus, Syria; 2Department of Urology, Al-Assad University Hospital, Damascus, SyriaCorrespondence: Omar Al Ayoubi, Email [email protected]: Ureteral endometriosis is an uncommon but potentially serious manifestation of deep endometriosis that may remain undetected until significant renal damage has occurred. We report the case of a 35-year-old woman with a 4-year history of right flank pain and macroscopic hematuria. She experienced recurrent bilateral hydronephrosis, managed previously with right-sided double J stents, while the left kidney was severely affected, asymptomatic, and diagnosed as non-functional for four years. Following removal of the right ureteral stent, she developed acute kidney injury necessitating urgent nephrostomy. Surgical exploration revealed distal ureteral fibrosis, and histopathological examination confirmed ureteral endometriosis. Ureteral reimplantation was successfully performed, leading to preservation of right renal function. This case underscores the diagnostic challenges of ureteral endometriosis and highlights the importance of early suspicion, multidisciplinary evaluation, and timely surgical management to prevent irreversible renal loss.Keywords: endometriosis, hydronephrosis, Lich-Gregoir technique, chronic flank pain