Ureter Reimplantation for Deep Infiltrative Endometriosis

Abstract

Study Objective

The objective of this video is to demonstrate the surgical technique for ureter re-implantation involving a deep infiltrating endometriotic lesion impinging on the bladder and causing left ureteral obstruction.

Design

Surgical video recording of steps to perform left ureter re-implantation after excision of deep infiltrating endometriotic lesion.

Setting

Operating Room.

Patients or Participants

This is a 37 year old G3P2 female with history of severe dysmenorrhea who presents with left flank pain and found to have moderately severe left hydroureteronephrosis secondary to endometriotic nodule compressing the left ureter.

Interventions

Robotic assisted total laparoscopic hysterectomy with bilateral salpingo-ophrectomy and left ureteral re-implantation.

Measurements and Main Results

There are a variety of techniques to repair and reimplant the ureter involved in extrinsic ureteral endometriosis. Surgical management of ureteral re-implantation in extrinsic ureteral endometriosis varies depending on location and depth of lesion. Complete excision of endometriotic lesion in this patient required intentional iatrogenic ureteral injury with reimplantation. This video will demonstrate ureter re-implantation with creation of ureteroneocystotomy and bladder hitch.

Conclusion

Ureteral re-implantation with ureteroneocystostomy and bladder hitch is an effective surgical management of deep infiltrating extrinsic ureteral endometriosis.