Clinical aspects and surgical treatment of urinary tract endometriosis: Our experience with 31 cases
Clinical aspects and surgical treatment of urinary tract endometriosis: Our experience with 31 cases
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DOI：
10.1016/j.eururo.2006.03.037
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发表时间：
2006-06-01
期刊：
影响因子：
23.4
通讯作者：
Cunico, Sergio Cosciani
中科院分区：
文献类型：
--
作者：
Antonelli, Alessandro;Simeone, Claudio;Cunico, Sergio Cosciani
目的：介绍和讨论泌尿系统子宫内膜异位症的临床和手术管理。方法：回顾性分析了一个数据库的手术患者子宫内膜异位症。结果：31例患者（发病率，2.6%，平均年龄，33.1岁）受到泌尿系统子宫内膜异位症（膀胱，12;输尿管，15;两者，4）。膀胱子宫内膜异位症表现为月经相关症状，并有典型的内窥镜图像，而输尿管受累则无特异性或无症状。所有受膀胱子宫内膜异位症影响并接受经尿道切除术的患者（2例）均发生膀胱复发;在接受腹腔镜输尿管松解术的6例患者中有2例观察到输尿管复发，在接受输尿管切除术和输尿管输尿管吻合术的2例患者中有1例观察到输尿管复发。相反，在14例接受部分膀胱切除术或9例接受输尿管切除术和输尿管膀胱吻合术的患者中没有观察到复发。最后，两名患者进行了肾切除术，由于终末期renal atrophic.Conclusions：膀胱镜检查是明智的女性盆腔子宫内膜异位症下尿路症状，上尿路应评估所有盆腔子宫内膜异位症患者排除无症状的输尿管参与。部分膀胱切除术用于治疗膀胱子宫内膜异位症时效果最好。输尿管松解术仅在局限性输尿管受累且无尿路梗阻的情况下才能成功，而梗阻性输尿管子宫内膜异位症应首选终末输尿管切除术和输尿管膀胱造口术。(c)2006 Elsevier B. V.保留所有权利。
Objectives: To present and discuss clinical and surgical management of urologic endometriosis.Methods: Retrospective review of a database on surgical patients with endometriosis.Results: Thirty-one patients (incidence, 2.6%; mean age, 33.1 yr) were affected by urologic endometriosis (bladder, 12; ureter, 15; both, 4). Bladder endometriosis was revealed by symptoms related to menses and showed a typical endoscopic picture, whereas ureteral involvement had a nonspecific or silent symptomatology. All patients affected by bladder endometriosis and undergoing transurethral resection (2 cases) developed a bladder recurrence; a ureteral recurrence was observed in two of six patients submitted to laparoscopic ureterolysis and in one of two patients submitted to ureterectomy with ureteroureterostomy. Conversely, no relapses were observed among the 14 patients who had partial cystectomy or the 9 who had ureterectomy and ureterocystoneostomy. Finally, two patients underwent nephrectomy due to end-stage renal atrophy.Conclusions: Cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms; the upper urinary tract should be evaluated in all patients with pelvic endometriosis to exclude asymptomatic ureteral involvement. Partial cystectomy gives the best results when used to treat bladder endometriosis. Ureterolysis can be successful only in case of limited ureteral involvement with no urinary obstruction, whereas terminal ureterectomy and ureterocystoneostomy should be preferred in case of obstructive ureteral endometriosis. (c) 2006 Elsevier B.V. All rights reserved.