Autori: Luisa Bono, Franca Servillo, Gioacchino Li Cavoli, Vitalba Azzolina, Rosanna Turdo, Carmela Zagarrigo, Barbara Oliva, Antonio Amato, Carlo Giammarresi, Camillo Carollo, Onofrio Schillaci, Rosalia Mongiovì, Angelo Tralongo, Flavia Caputo.
Affiliazioni: UOC Nefrologia-Dialisi-Trapianto Renale, ARNAS Civico e Di Cristina Palermo
Ureteral endometriosisis (intrinsic or more frequent extrinsic to ureteral wall) is infrequent (0.1% of all patients with endometriosis). The most frequent symptoms and signs are nonspecific and sometimes can mimic those of ureteral malignancy. Our experience. A 41-year-old woman with previous normal renal function and without history of previous pregnancy, was admitted to hospital because of recurrent unilateral right flank pain, related with her mestrual periods. Physical examination was unremarkable. Abdominal ultrasonography showed enlarged right kidney (13,9 cm) with hydronephrosis and a round anechoic mass (3,6 cm) in right ovary. CT Abdomen confirmed these findings and highlighted delay of contrast elimination after 60 min. of injection (Fig. 1) and right ureteral dilatation up to 1,5 cm from ureteral-bladder junction. Creatinine was 1,22 mg/dl. Urine culture was negative; urinary sediment didn’t show hematuria or pyuria; urine cytology was negative for malignant cells. Ureteroscopy confirmed a distal ureteric narrowing. The patient underwent to right ureteral stenting with reduction of creatinine to 0,63 mg/dl but the right flank pain continued with the same characteristics. Abdominal RMN was performed confirming right ureteral compression by a right ovarian mass. The patient underwent to exeresis of ovarian mass. Hystologic examination of ureteral wall confirmed diagnosis of intrinsic endometriosis. The involvement of the urinary tract is rare in endometriosis but it is now increasingly recognized. Clinical suspicion of pelvic endometriosis should be considered in the differential diagnosis for a woman with obstructive uropathy and ureteric mass or chronic backache.
