当院初診時に片側腎機能の廃絶を認めた尿管子宮内膜症３例の検討

抄録

Introduction: The prognosis of ureteral endometriosis is good if proper treatment is applied, but lack of subjective symptoms often lead to poor treatment. The disease comprises as low as 0.1％ of all pelvic endometriosis and 10％ of urinary tract endometriosis. Therefore, both patients and doctors are usually unaware of the seriousness of the disease, and in some cases, patients do not seek medical attention although problems are noted during examinations. Even when medical attention is sought, treatment is delayed because of the lack of a proper diagnosis. In this report, we describe three cases in which unilateral renal function was impaired due to ureteral endometriosis.

Case 1: A 51-year-old woman was diagnosed with hydronephrosis at a checkup two years ago, but she had no symptoms and did not seek medical care. She visited her previous doctor for dysmenorrhea, irregular bleeding, and hematuria, and was referred to our hospital after CT and MRI scans revealed uterine fibroids, rectal endometriosis, and a left ureteral tumor. In addition to laparoscopic hysterectomy, bilateral adnexal resection, and low anterior resection, laparoscopic total left nephroureterectomy was performed.

Case 2: A 52-year-old woman was diagnosed with adenomyosis at another hospital more than 10 years ago, but the condition was difficult to treat because of poorly controlled hypertension. Graves'disease was diagnosed three months before her first visit, and preoperative examination showed abnormal renal function. CT showed left hydronephrosis, right nonfunctioning kidney, and uterine adenomyosis. She underwent the robot-assisted total hysterectomy, bilateral adnexal resection, and left vesicoureteral neoanastomosis.

Case 3: A 48-year-old woman visited her previous doctor because of abdominal pain and vomiting. MRI revealed multiple uterine fibroids and a left nonfunctioning kidney. Robot-assisted total hysterectomy, bilateral salpingo-oophorectomy, and left ureterolysis were performed.

Conclusion: Even in advanced cases of ureteral endometriosis, about half of the patients have few symptoms. Asymptomatic hydronephrosis should lead to a suspicion of ureteral endometriosis. It is also important to consider ureteral endometriosis even if adnexal lesions are not suspected.