Endometriosis Surgery

*Recent Advances in Laparoscopic Surgery*

s00464-012-2530-y

10.4103/0972-9941.195573

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Chapter 5

Abstract

New Paradigms in Endometriosis

It is estimated that 2% of endometriosis cases involve the urinary tract and that the ureter is involved in up to 30% of these cases, or 0.6% of all endometriosis cases. Increasingly, the standardization and systematization of surgical treatment of endometriosis require the surgeon to have knowledge of the surgical spaces and the ureteral and surrounding pelvic anatomy in order to carry out a cytoreductive surgery that is as possible. A thorough workup is essential for the differentiation of intrinsic or extrinsic endometriosis of the ureter. The use of the resonance imaging preoperatively and ureteroscopy intraoperatively is now considered indispensable. The decision and choice of the best technique will be guided by the diagnosis (intrinsic or extrinsic), the location of the lesions, the length of the involved segment (greater or less than 3 cm), vitality of the ureter stumps, and anastomosis without tension. The main alternatives are ureterolysis and dilatation with balloon catheter which is performed for extrinsic endometriosis more than 85% of the time and ureterectomy for intrinsic endometriosis. To perform the reconstruction, the techniques with end-to-end anastomosis with the distal ureter stump or ureterovesical reimplantation are used. Increasingly, with better knowledge of the distal ureter anatomy, easier access through laparoscopy and in contradiction to the current recommendations, we are verifying that the end-to-end anastomosis has become the preferred option or procedure of choice for ureteral reconstruction,

Surgery of the Distal Ureter

Rodrigo Ribeiro Vieiralves, Renata Teles Buere

José Anacleto Dutra de Resende Júnior,

with ureterovesical reimplantation the second option.

new surgical approach

1. Introduction

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Keywords: endometriosis, ureter, laparoscopic surgery, new technique,

Endometriosis involving the urinary tract is rare, affecting only 1–2% of women with endometriosis. The vast majority of these cases – 80–85% involve the bladder. Ureteral endometriosis occurs in just 15% of cases. Ureteral involvement usually occurs near its insertion in the bladder, just above the ureterovesical junction (UVJ), near where it crosses the uterine artery [1–6]. We believe that this prevalence is underestimated due to the scarce data in the literature and the lack of standardization of the surgical technique around the world in different countries. Based on our practical experience, we believe that extrinsic ureter involvement is

and Claudio Peixoto Crispi
