OBJECTIVE To illustrate the surgical management of advanced endometriosis causing extrinsic ureteral compression. DESIGN Video description of the case, demonstration of the surgical technique, reevaluation at 14-year follow-up, and review of urogenital endometriosis. Patient provided consent for the video recording and publication. This surgical report with no identifying patient data was exempt from Institutional Review Board approval. SETTING Tertiary referral center. PATIENT(S) A 42-year-old nulligravida with a known history of endometriosis presented with persistent pelvic pain and no other specific symptoms. She had previously undergone a diagnostic laparoscopy demonstrating advanced endometriosis involving multiple organs, including the urinary tract. She was referred to us for further surgical management. Preoperative intravenous pyelogram showed partial obstruction and constriction of a long portion of the midpelvic and distal left ureter with proximal hydroureter, consistent with extrinsic ureteral compression. INTERVENTION(S) The patient underwent operative video laparoscopy using a multipuncture technique, with enterolysis, extensive left ureterolysis, shaving of periureteral constrictive fibrosis and endometriosis, cystoscopy, and placement of left ureteral stent. MAIN OUTCOME MEASURE(S) There was extensive endometriosis and fibrotic adhesions involving the left pelvic sidewall. Proximal hydroureter was noted to the pelvic inlet secondary to severe periureteral fibrosis from the pelvic brim to the bladder meatus, with significant narrowing of the pelvic ureter. The endometriosis was resected using hydrodissection and shaving with a carbon dioxide laser. Histopathologic evaluation of the resection specimens confirmed endometriosis. RESULT(S) An intravenous pyelogram performed 4 weeks postoperatively revealed ureteral patency and resolving hydroureter, and her ureteral stent was removed. Annual renal ultrasounds for the subsequent 2 years were normal. Fourteen years later, she remained asymptomatic on no suppressive treatment. A follow-up intravenous pyelogram was performed and showed a normal urinary tract with bilateral ureteral patency and no recurrent strictures or hydroureter. CONCLUSION(S) In selected cases, conservative shaving of periureteral fibrotic endometriosis avoids ureteral resection and has acceptable outcomes.

中文翻译：

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使用剃须技术治疗子宫内膜异位症引起的部分输尿管梗阻

目的 说明导致输尿管外受压的晚期子宫内膜异位症的手术治疗。设计 病例视频描述、手术技术演示、14 年随访时的重新评估以及泌尿生殖器子宫内膜异位症的回顾。患者同意录像和出版。这份没有识别患者数据的手术报告免于机构审查委员会的批准。设置 三级转诊中心。患者 一名 42 岁的孕妇，有子宫内膜异位症的已知病史，表现为持续性骨盆疼痛，无其他特定症状。她之前接受了诊断性腹腔镜检查，证明晚期子宫内膜异位症涉及多个器官，包括泌尿道。她被转介给我们进行进一步的手术治疗。术前静脉肾盂造影显示盆腔中部和左输尿管远端的长部分部分梗阻和收缩，近端输尿管积水，与输尿管外受压一致。干预（S） 患者接受了使用多重穿刺技术的手术视频腹腔镜检查，其中包括肠溶解、左输尿管广泛溶解、输尿管周围缩窄性纤维化和子宫内膜异位症、膀胱镜检查和左侧输尿管支架置入。主要结局指标 左侧盆腔侧壁有广泛的子宫内膜异位症和纤维化粘连。在骨盆入口处注意到近端输尿管积水，继发于从骨盆边缘到膀胱口的严重输尿管周围纤维化，骨盆输尿管显着变窄。子宫内膜异位症使用水分离术和二氧化碳激光剃须切除。切除标本的组织病理学评估证实了子宫内膜异位症。结果（S）术后 4 周进行的静脉肾盂造影显示输尿管通畅，输尿管积水正在消退，并取出输尿管支架。随后 2 年的年度肾脏超声检查正常。十四年后，她在没有接受抑制治疗的情况下仍然没有症状。进行了后续静脉肾盂造影，结果显示尿路正常，双侧输尿管通畅，无复发性狭窄或输尿管积水。结论（S）在选定的病例中，输尿管周围纤维化子宫内膜异位症的保守剃须避免了输尿管切除术，并且具有可接受的结果。切除标本的组织病理学评估证实了子宫内膜异位症。结果（S）术后 4 周进行的静脉肾盂造影显示输尿管通畅，输尿管积水正在消退，并取出输尿管支架。随后 2 年的年度肾脏超声检查正常。十四年后，她在没有接受抑制治疗的情况下仍然没有症状。进行了后续静脉肾盂造影，结果显示尿路正常，双侧输尿管通畅，无复发性狭窄或输尿管积水。结论（S）在选定的病例中，输尿管周围纤维化子宫内膜异位症的保守剃须避免了输尿管切除术，并且具有可接受的结果。切除标本的组织病理学评估证实了子宫内膜异位症。结果（S）术后 4 周静脉肾盂造影显示输尿管通畅，输尿管积水正在消退，并取出输尿管支架。随后 2 年的年度肾脏超声检查正常。十四年后，她在没有接受抑制治疗的情况下仍然没有症状。进行了后续静脉肾盂造影，结果显示尿路正常，双侧输尿管通畅，无复发性狭窄或输尿管积水。结论（S）在选定的病例中，输尿管周围纤维化子宫内膜异位症的保守剃须避免了输尿管切除术，并且具有可接受的结果。随后 2 年的年度肾脏超声检查正常。十四年后，她在没有接受抑制治疗的情况下仍然没有症状。进行了后续静脉肾盂造影，结果显示尿路正常，双侧输尿管通畅，无复发性狭窄或输尿管积水。结论（S）在选定的病例中，输尿管周围纤维化子宫内膜异位症的保守剃须避免了输尿管切除术，并且具有可接受的结果。随后 2 年的年度肾脏超声检查正常。十四年后，她在没有接受抑制治疗的情况下仍然没有症状。进行了后续静脉肾盂造影，结果显示尿路正常，双侧输尿管通畅，无复发性狭窄或输尿管积水。结论（S）在选定的病例中，输尿管周围纤维化子宫内膜异位症的保守剃须避免了输尿管切除术，并且具有可接受的结果。