Urinary tract involvement in endometriosis: current evidence and clinical insights into navigating diagnosis and management

PURPOSE OF REVIEW: This review synthesizes current evidence on pathophysiology, diagnosis, and management strategies for endometriosis of the urinary tract, emphasizing the urgent need for multidisciplinary care to prevent long-term complications. RECENT FINDINGS: Urinary tract endometriosis is an increasingly recognized subset of deep infiltrating endometriosis that poses a significant risk for severe morbidity. Advances in specialized transvaginal ultrasound and pelvic MRI have improved preoperative mapping of urinary tract endometriosis. Recent literature highlights a shift toward collaborative surgical planning between gynecologic and urologic surgeons. While medical management remains suppressive, surgical management via laparoscopy or robotic surgery demonstrates low recurrence rates and high patient satisfaction. However, the lack of standardized surgical criteria and postoperative surveillance protocols remains a challenge in clinical practice. SUMMARY: Urinary tract endometriosis requires a high index of clinical suspicion, particularly in patients with known deep infiltrating or parametrial nodules. Early recognition and individualized multidisciplinary management are critical to prevent renal deterioration and improve outcomes. Future research should focus on establishing evidence-based clinical pathways to standardize surgical decision-making and optimize long-term surveillance of renal function.