Endoureterotomy is not a sufficient treatment for intrinsic ureteral endometriosis

Aim: To investigate whether intrinsic ureteral endometriosis could be managed by laser endoureterotomy.

Material and methods: We studied retrospectively 6 patients with intrinsic ureteral endometriosis who underwent laser endoureterotomy and reviewed their clinical data. Pathological sections of them have also been studied by immunohistochemistry for expressional levels of oestrogen (ER) and progesterone (PR) receptors. Ten sections of normal endometrium were included as a control.

Results: Five patients had recurrence of ureteral stricture within 6 months postoperatively despite hormonal therapy for 3 to 6 months. One patient had recurrence 8 months after endoureterotomy. Two patients had secondary surgery for ureteroureterostomy and pathology confirmed recurrence of endometriosis. Immunohistochemistry revealed decreased ER and PR expression compared to the control.

Conclusions: Endoureterotomy with hormonal therapy may not be suitable for ureteral endometriosis due to inadequate cutting and expressional change of ER and PR.