Obstructive uropathy associated with primary ureteral endometrioma: case report and review of the literature
DOI:
https://doi.org/10.5489/cuaj.1098Abstract
We report the case of a 56-year-old postmenopausal woman who
presented with incidental left hydronephrosis during an investigation
for a gastrointestinal complaint. The patient denied any history
of flank pain or hematuria. Contrast-enhanced computed
tomography revealed severe right-sided ureterohydronephrosis as
well as renal atrophy. The contralateral kidney was normal, as was
the patient’s overall renal function. A retrograde ureterogram
demonstrated complete ureteral obstruction 4 cm proximal to the
ureterovesical junction. Subsequent ureteroscopy revealed a polypoid
mass completely occupying the ureteral lumen, of which the
biopsies demonstrated inconclusive atypical urothelial changes.
The patient underwent a laparoscopic nephrectomy with open
dissection of the distal ureter. The patient recovered well postoperatively.
Final pathology revealed a benign obstructing
endometrioma without evidence of invasion from periureteral
tissue. This appears to be the first reported case of asymptomatic
primary ureteral endometrioma with secondary renal atrophy.
Earlier investigation and treatment may have allowed for renal
preservation earlier in the course of the disease.
Nous décrivons le cas d’une femme ménopausée de 56 ans présentant
une hydronéphrose gauche découverte de façon fortuite au
cours d’un examen mené pour donner suite à des symptômes gastro-
intestinaux. La patiente n’avait pas d’antécédents de douleur
au flanc ou d’hématurie. Une TDM avec agent de contraste a
révélé une urétéro-hydronéphrose droite importante accompagnée
d’une atrophie rénale. Le rein controlatéral et la fonction rénale
globale de la patiente ne présentaient aucune anomalie. Une
urétérographie par voie rétrograde a permis d’observer une obstruction
complète de l’uretère proximale à 4 cm de la jonction urétérovésicale.
Une urétéroscopie subséquente a révélé une masse polypoïde
occupant la totalité de la lumière urétérale et des analyses
après biopsie ont montré des changements atypiques non concluants
au niveau de l’épithélium urinaire. La patiente a subi une
néphrectomie par laparoscopie avec dissection ouverte de l’uretère
distale. La patiente s’est bien rétablie après l’intervention. Le
rapport final de pathologie a révélé un endométriome obstructif
bénin sans signe d’invasion des tissus péri-urétéraux. Il semble
que ce soit ici le premier cas signalé d’endométriome urétéral
primitif asymptomatique avec atrophie rénale secondaire. Un examen
et un traitement réalisés plus tôt dans le cours de l’évolution
de la maladie auraient pu permettre la préservation du rein.
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