Urinary tract endometriosis in patients with deep infiltrating endometriosis Prevalence symptoms management and proposal for a new clinical classification

Involvement of the urinary tract is frequent in patients with deep infiltrating endometriosis, and the probability of ureteral involvement is in linear correlation to the size of endometriotic rectovaginal nodules.

Laura Knabben, Sara Imboden, M.D., Bernhard Fellmann, M.D., Konstantinos Nirgianakis, M.D., Annette Kuhn, M.D., Michael D. Mueller, M.D.

Volume 103, Issue 1, Pages 147-152


To analyze the prevalence of urinary tract endometriosis (UTE) in patients with deep infiltrating endometriosis (DIE) and to define potential criteria for preoperative workup.

Retrospective study.

University hospital.

Six hundred ninety-seven patients with endometriosis.

Excision of all endometriotic lesions.

Main Outcome Measure(s):
Correlation of preoperative features and intraoperative findings in patients with UTE.

Out of 213 patients presenting DIE, 52.6% suffered from UTE. In patients with ureteral endometriosis, symptoms were not specific. Among the patients with bladder endometriosis, 68.8% complained of urinary symptoms compared to 7.9% in the group of patients without UTE. In patients with rectovaginal endometriosis, the probability of ureterolysis showed a linear correlation with the size of the nodule. We found that 3 cm in diameter provided a specific cutoff value for the likelihood of ureteric involvement.

The prevalence of UTE has often been underestimated. Preoperative questioning is important in the search for bladder endometriosis. The size of the nodule is one of the few reliable criteria in preoperative assessment that can suggest ureteric involvement. We propose a classification of ureteral endometriosis that will allow the standardization of terminology and help to compare the outcome of different surgical treatment in randomized studies.

  • Jason M. Franasiak

    A very interesting manuscript…many thanks. It is mentioned that the authors are convinced early lesions should be treated to prevent ureteral stenosis and potentially loss of the kidney. Are you aware of any data to support this notion? Any thoughts on resection of large lesions followed by medical treatment and how that might compare to the success in kidney sparing for deep infiltrating endometriosis cases that have early ureteral lesions?

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