Urinary tract endometriosis consists of lesions affecting the ureters and the bladder. The lesions can affect from surface or inside.
Bladder endometriosis followed by ureteral endometriosis are the most common forms of urinary tract endometriosis. Bladder endometriosis can be found in 85% of cases, and ureteral endometriosis is found in approximately 50% of deep endometriosis cases. It can be intrinsic and extrinsic. In extrinsic endometriosis, tissues are found on the surface, and in intrinsic endometriosis, tissues may infiltrate the muscle, lamina propria, and ureteral lumen, leading to proximal dilatation of the ureter with stricture.
Other types of urinary tract endometriosis are renal endometriosis and urethral endometriosis.
Depending on how much the ureters are affected, several surgical procedures can be done. These are:
- Ureteral shaving consists of freeing the uterus from the blockage caused by adhesions, before proceeding to resect the nodule. It is a difficult procedure due to the anatomy of the ureters.
- Ureteroneocystostomy consists of the reimplantation of the ureter into the bladder and it is done for partial or complete hydronephrosis.
- Ureteroureterostomy refers to an end-to-end anastomosis of the segments of the same ureter, with excision of the intervening injured or scarred ureter
In case of bladder endometriosis, a cystectomy can be done.