Laparoscopy for ureteral endometriosis: Surgical details, long-term follow-up, and fertility outcomes

Objective To evaluate perioperative details, long-term outcomes, and postsurgical fertility in case of laparoscopic ureterolysis for deep endometriosis. Design Retrospective analysis of prospectively collected data. Setting Academic research center. Patient(s) One hundred nine consecutive women who underwent laparoscopic ureterolysis for deep endometriosis. Intervention(s) Laparoscopic excision of ureteral endometriosis (ureteral shaving was attempted in all cases). Main Outcome Measure(s) Perioperative details, long-term outcomes, fertility rates, and need for secondary surgery, stratifying on presence/absence of hydronephrosis. Predictors of longer operative time, pain recurrence, and fertility were also investigated. Result(s) No conversion to open surgery was necessary. Intraoperative ureteral injury occurred in one case (0.9%). Nine women (8.3%) underwent ureteral stenting. Eight cases (7.3%) of mild postoperative complications were registered; no case of severe complications or postoperative ureteral fistula occurred. An increase was observed in the risk of short-/long-term adverse outcomes, according to the grade of preoperative hydronephrosis. Of the 80 women with available follow-up data, secondary ureteral procedures were necessary in 5 women (6.3%), whereas 22 patients (27.5%) had recurrence of endometriosis symptoms. Among the 36 women who wished to conceive, a total of 26 pregnancies were registered in 20 women (55.6%). The miscarriage rate was 15.6%. Hydronephrosis grade ≥2 was independently associated with longer operative time and higher rate of symptoms recurrence. Adjuvant hormonal therapy after ureterolysis was the only independent factor associated with lower fertility rates. Conclusion(s) Laparoscopic ureterolysis is a safe procedure, with encouraging pregnancy rates and satisfactory long-term results. However, hydronephrosis grade ≥2 is associated with worse outcomes.