Laparoscopy for ureteral endometriosis Surgical details long term follow up and fertility outcomes

Laparoscopic ureteral shaving for deep endometriosis can be safely and effectively accomplished, with a low risk of complications, encouraging fertility outcomes and a low probability of disease relapse.

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Authors

Stefano Uccella, M.D., Ph.D., Antonella Cromi, M.D., Ph.D., Jvan Casarin, M.D., Giorgio Bogani, M.D., Ciro Pinelli, M.D., Maurizio Serati, M.D., Fabio Ghezzi, M.D.

Volume 102, Issue 1, Pages 160–166.e2

Abstract

Objective:

To evaluate perioperative details, long-term outcomes, and postsurgical fertility in case of laparoscopic ureterolysis for deep endometriosis.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Academic research center.

Patient(s):

One hundred nine consecutive women who underwent laparoscopic ureterolysis for deep endometriosis.

Intervention(s):

Laparoscopic excision of ureteral endometriosis (ureteral shaving was attempted in all cases).

Main Outcome Measure(s):

Perioperative details, long-term outcomes, fertility rates, and need for secondary surgery, stratifying on presence/absence of hydronephrosis. Predictors of longer operative time, pain recurrence, and fertility were also investigated.

Result(s):

No conversion to open surgery was necessary. Intraoperative ureteral injury occurred in one case (0.9%). Nine women (8.3%) underwent ureteral stenting. Eight cases (7.3%) of mild postoperative complications were registered; no case of severe complications or postoperative ureteral fistula occurred. An increase was observed in the risk of short-/long-term adverse outcomes, according to the grade of preoperative hydronephrosis. Of the 80 women with available follow-up data, secondary ureteral procedures were necessary in 5 women (6.3%), whereas 22 patients (27.5%) had recurrence of endometriosis symptoms. Among the 36 women who wished to conceive, a total of 26 pregnancies were registered in 20 women (55.6%). The miscarriage rate was 15.6%. Hydronephrosis grade ≥2 was independently associated with longer operative time and higher rate of symptoms recurrence. Adjuvant hormonal therapy after ureterolysis was the only independent factor associated with lower fertility rates.

Conclusion(s):

Laparoscopic ureterolysis is a safe procedure, with encouraging pregnancy rates and satisfactory long-term results. However, hydronephrosis grade ≥2 is associated with worse outcomes.

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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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