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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2018  |  Volume : 29  |  Issue : 4  |  Page : 1010-1011
Ureteral obstructive nephropathy due to compression by intrinsic endometriosis of the ovary


Nephrology Dialysis with Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy

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Date of Submission05-Jan-2018
Date of Acceptance09-Jan-2018
Date of Web Publication28-Aug-2018
 

How to cite this article:
Bono L, Li Cavoli G, Giammarresi C, Turdo R, Li Cavoli TV, Oliva B, Caputo F. Ureteral obstructive nephropathy due to compression by intrinsic endometriosis of the ovary. Saudi J Kidney Dis Transpl 2018;29:1010-1

How to cite this URL:
Bono L, Li Cavoli G, Giammarresi C, Turdo R, Li Cavoli TV, Oliva B, Caputo F. Ureteral obstructive nephropathy due to compression by intrinsic endometriosis of the ovary. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2019 Nov 12];29:1010-1. Available from: http://www.sjkdt.org/text.asp?2018/29/4/1010/239665
To the Editor,

Endometriosis, i.e., the presence of active endometrial tissue outside the uterine cavity, is a common disease among premenopausal women. Urinary tract endometriosis (UTE) is an infrequent form of deep infiltrating endo-metriosis. Bladder endometriosis is the most frequent UTE. Ureteral endometriosis (intrinsic or more frequent extrinsic to the ureteral wall) is unusual (approximately 0.1% of all patients with endometriosis).[1] The most frequent symptoms (urinary frequency, flank discomfort, disuria, and hematuria) are nonspecific, and diagnosis is often challenging. Sometimes, the symptoms and signs of ureteral endometriosis can mimic those of ureteral malignancy.[2] We report our experience. A 41-year-old woman with previously normal renal function and without a history of previous pregnancy was admitted to hospital because of recurrent unilateral right flank pain, related with her menstrual periods, with radiation to her anterior right abdomen, without other associated symptoms and not related to postural change. Physical examination was unremarkable. Abdominal ultrasonography showed enlarged right kidney (13.9 cm of diameter) with hydronephrosis and a round anechoic mass (3.6 cm of diameter) in right ovary. Computed tomography confirmed these findings and highlighted delay of contrast elimination after 60 min of injection [Figure 1] and right ureteral dilatation up to 1.5 cm from the ureteral-bladder junction. Serum creatinine level was 1.22 mg/dL. The urine culture indicated no bacterial growth; urinary sediment did not show hematuria or pyuria, and urine cytology was negative for the presence of malignant cells. Ureteroscopy was performed and confirmed a distal ureteric narrowing. The patient underwent to right ureteral stenting with reduction of serum creatinine level to 0.63 mg/dL, but the right flank pain continued with the same characteristics. Abdominal magnetic resonance imaging was then performed confirming right ureteral compression by a right ovarian mass. The patient underwent to exeresis of ovarian mass. The histologic examination confirmed the diagnosis of ovarian and ureteral endometriosis. The involvement of the urinary tract is rare in endometriosis, but it is now increasingly recognized. Ureteral endometriosis, sometimes clinically silent, can result in ureteral obstruction with hydronephrosis and loss of kidney function.[3],[4] Clinical suspicion of pelvic endometriosis should be considered in the differential diagnosis for a woman with obstructive uropathy and ureteric mass or a chronic backache even in the absence of hematuria or pelvic symptoms.[5]
Figure 1: Abdominal contrast computed axial tomography: enlarged right kidney with hydro-nephrosis and delay of contrast elimination.

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Conflict of interest: None declared.

 
   References Top

1.
Mason RJ, Alamri A, Gusenbauer K, Kapoor A. Intrinsic ureteral endometriosis as a cause of unilateral obstructive uropathy. Can Urol Assoc J 2016;10:E119-21.  Back to cited text no. 1
    
2.
Hsieh MF, Wu IW, Tsai CJ, Huang SS, Chang LC, Wu MS. Ureteral endometriosis with obstructive uropathy. Intern Med 2010;49:573-6.  Back to cited text no. 2
    
3.
Generao SE, Keene KD, Das S. Endoscopic diagnosis and management of ureteral endometriosis. J Endourol 2005;19:1177-9.  Back to cited text no. 3
    
4.
Pateman K, Holland TK, Knez J, et al. Should a detailed ultrasound examination of the complete urinary tract be routinely performed in women with suspected pelvic endometriosis? Hum Reprod 2015;30:2802-7.  Back to cited text no. 4
    
5.
Gupta SS, Singh O, Shukla S, Mathur RK. Rare case of ureteral endometriosis presenting as hydronephrotic kidney. Saudi J Kidney Dis Transpl 2011;22:130-3.  Back to cited text no. 5
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Correspondence Address:
Dr. Gioacchino Li Cavoli
Nephrology Dialysis with Renal Transplant Department, Civico and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.239665

PMID: 30152447

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