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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (6): 955-960    DOI: 10.31083/j.ceog.2020.06.2092
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Deep infiltrating endometriosis as a cause of severe urogynecological complications despite invasive treatment - report of two cases from the center of endometriosis surgery
D. Filipecka-Tyczka1, A. Kajdy1, B.P. Siekierski1, M. Stańczyk2, A. Rogowski3, M. Rabijewski1, R.B. Maksym1, *()
1Department of Reproductive Health, Centre of Postgraduate Medical Education, 01-004, Warsaw, Poland
2Department of General, Oncologic and Trauma Surgery of Wolski Hospital, Warsaw, 01-211, Poland
3Collegium Medicum, Cardinal Stefan Wyszynski University, 01-938, Warsaw; Department of Obstetrics and Gynecology, Institute of Mother and Child; 01-211 Warsaw, Poland
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Abstract  

Endometriosis involvement of the urological tract may lead to significant disabilities. The involvement of the urological tract gives rise to severe complications that burden patient health and quality of life. Two cases of patients with severe urogynecological complications after surgery of deep infiltrating endometriosis were analyzed. Last resort radical surgical treatment did not stop the progression of the disease and failed to prevent further deterioration despite concomitant hormone therapy. Careful clinical consideration is recommended to plan an effective therapeutic strategy and the extent of the surgery for this multidisciplinary and complex disease. The treatment should start and be proceed by a dedicated and experienced team. Radical surgery including a total hysterectomy with a salpingo-oophorectomy could be necessary. Although a radical dissection increases the chances of recovery and long-term remission, it is also associated with an increased risk of serious short-term and long-term postoperative complications. In presented cases, the infiltration of the ureter by endometriosis caused non-symptomatic kidney function loss. The radical surgical treatment of deep infiltrating endometriosis did not stop the progression of a disease and was associated with severe urogynecological complications. Screening for pyelocaliectasis in patients with deep endometriosis could be considered as an important part of preoperative examination and postoperative follow-up.

Key words:  Deep infiltrating endometriosis      Gynecological surgery      Pyelocaliectasis      Kidney loss      Urogynecological complications      Ureteroneocystostomy     
Submitted:  24 March 2020      Accepted:  15 June 2020      Published:  15 December 2020     
Fund: 2011/03/N/NZ5/05899/NCN (R.M.)
*Corresponding Author(s):  R.B. Maksym     E-mail:  radoslaw.maksym@cmkp.edu.pl

Cite this article: 

D. Filipecka-Tyczka, A. Kajdy, B.P. Siekierski, M. Stańczyk, A. Rogowski, M. Rabijewski, R.B. Maksym. Deep infiltrating endometriosis as a cause of severe urogynecological complications despite invasive treatment - report of two cases from the center of endometriosis surgery. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 955-960.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.06.2092     OR     https://ceog.imrpress.com/EN/Y2020/V47/I6/955

Figure 1.  — Schematic chronological representation of main surgical procedures performed in case #1 (left side) and case #2 (right side). Clinical symptoms of endometriosis progressively worsened despite gradual escalation of surgical interventions.

Figure 2.  — Transvaginal ultrasound scan of a cystic structure (presumably an endometriotic cystic nodule) above the vaginal vault of patient case #2 (as seen on November 27th, 2017). The cyst imitates common ovarian endometrioma, however, at the time of the US-scan the patient was after a bilateral adnexectomy. The size of the cystic structure is 34 × 44 × 35 mm.

Figure 3.  — Transvaginal ultrasound scan showing the evolution of a cystic structure above the vagina vault of patient #2 in year 1 follow-up (as seen on November 12th, 2018). The evolution of the lesion is not characteristic of a common endometrioma. The size of the cystic structure is 26 × 22 × 27 mm.

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