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671 Laparoscopic management of ureteral endometriosis in a patient with bilateral complete ureteral duplication presenting with hydronephrosis
  1. Murat Api1,
  2. Ismail Baglar2 and
  3. Esra Keles1
  1. 1University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital, Departmant of Gynecologic Oncology, Istanbul, Türkiye
  2. 2University of Health Sciences Turkey, Kartal Lütfi Kirdar City Hospital, Department of Obstetrics and Gynecology, Istanbul 34668, Turkey, Istanbul, Türkiye


Introduction/Background Ureteral endometriosis is a very rare but serious form of infiltrating endometriosis. Ureteral endometriosis occurs in approximately 1% of women with endometriosis. Intrinsic ureteral endometriosis is even rarer, occurring in only one-fifth of all cases of endometriosis of the ureter. In addition, bilateral complete ureteral duplication occurs in 1 in 500 persons and is presents on 0.3% of excretory urograms. Herein, we demonstrate how laparoscopic treatment can be safely managed in a patient with bilateral double ureters presenting with hydronephrosis due to ureteral endometriosis.

Methodology We present a 38-year-old woman with bilateral double complete ureters with ureteral endometriosis complicated with left hydronephrosis. Magnetic resonance imaging (MRI) revealed the presence of an endometriotic nodule of 48*33*29 mm lesion over the uterosacral ligament and deeply infiltrating the left ureter. Renal function was deminished at 19% in renal scintigraphy on left side and both ureters were obstructed and hydroureteronephrosis was revealed in DMSA scan. Preoperative bilateral left ureter double-J stent insertion was performed and an intrinsic ureter endometriosis was histologically confirmed. The patient in this video has given permission for the video to be published and posted online, including on various social media platforms, the journal website, scientific literature websites and relevant websites.

Results Intervention (s): 1. Development of the retroperitoneal space and bilateral duplication of ureters were visualized.

2. Ureterolysis was performed.

3. Ligation of left uterine artery and hypogastric artery.

4. Suturing of the bladder defect with 1–0 polyglactin suture.

5. The endometriotic nodule was excised.

Conclusion Herein, we demonstrate an extremely rare case showing laparoscopic management in a patient with bilateral double ureters complicated with hydronephrosis due to ureteral endometriosis. It may be suggested that laparoscopic surgery is feasible for deep infiltrating endometriosis involving ureters.

Disclosures None.

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