Ureteral endometriosis in patients with deep infiltrating endometriosis: characteristics and management from a single-center retrospective study

  • Zhijun Hu
  • Peiquan Li
  • Qing Liu
  • Hong Zhu
  • Yuxin Sun
  • Xuanxuan Zhao
  • Lei Xie
  • Kaijiang LiuEmail author
General Gynecology



As a serious type of deep infiltrating endometriosis (DIE), ureteral endometriosis (UE) can result in decreased kidney function. The aims of this study are to investigate risk factors and surgical treatments for UE.


The study enrolled 329 patients with deep infiltrating endometriosis, who were treated with laparoscopic surgery between January 2014 to September 2018. All patients were divided into one of two groups: UE or non-UE. Clinical information and other surgery variables of the two groups were examined.


Out of 329 patients with DIE, 68 (20.67%) cases of UE were diagnosed. Among them, 37 patients also had hydroureteronephrosis. In a multivariate analysis, the variables revised American Fertility Society (rAFS) stage IV, uterosacral ligament (USL) DIE lesion ≥ 3 cm in diameter and previous surgery for endometriosis significantly increased the risk of UE. A total of 27.03% (10/37) of patients with UE and hydroureteronephrosis showed decreased kidney function. Ureterolysis was performed in 59 patients, and an ureteroneocystostomy was performed in 9 patients. A double-J stent was placed in 37 patients with UE. Only 1 patient developed acute pyelonephritis postoperatively. During more than 2 years of follow-up, no patient experienced recurrence.


The variables of rAFS stage IV, USL DIE lesion ≥ 3 cm in diameter and previous surgery for endometriosis significantly increased the risk of UE. Laparoscopic ureterolysis and ureteroneocystostomy are feasible and safe procedures with low complication and recurrence rates.


Ureteral endometriosis Ureterolysis Ureteroneocystostomy Hydroureteronephrosis Kidney function 


Author contributions

ZJH: protocol development, data collection and management, data analysis, manuscript writing, responsible surgeon. PQL: protocol development, data collection and management, data analysis, manuscript writing, responsible surgeon. QL: data collection, data analysis, responsible surgeon. HZ: data collection, data analysis, responsible surgeon, YXS: data collection, responsible surgeon, XXZ: data collection, responsible surgeon, LX: data collection, responsible surgeon, KJL: protocol development, data management, data analysis, manuscript editing, responsible surgeon.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynecologic OncologyRenji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina

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