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

Capsule:
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.

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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