尿管endometriosis症例

概要

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We presented a case of ureteral endometriosis causing obstruction. The patient (45-59), aged 34, was hospitalized on May 19, 1970 because of pain in the right lower quadrant and gross hematuria. Bladder irritability was absent. She had a past history of right oophorectomy because of right ovarial cyst. Physical examination revealed no abnormalities except a mass in the Douglas pouch on pelvic examination. Excretory urogram showed right hydronephrosis and hydroureter. Cystoscopy revealed a normal bladder. Retrograde pyelography was performed. Catheterization of the right ureter demonstrated a high degree of stricture at the distal third. Exploration was done through a low midline incision. The area of obstruction was explored and abnormal periureteral tissue was removed. A complete hysterectomy was performed along with excision of ovarian cyst on the left. A right ureteroneocystostomy was done by the LeadbetterPolitano technique. Pathological descriptions were as follows. A section of removed tissue revealed small islands of endometrium in the periureteral fibrous tissue, but no islands in mucous membrane, muscular layer and the serosa of the ureter. Final diagnosis was right hydronephrosis and hydroureter caused by extrinsic endometriosis of the right ureter. The patient was entirely well and a 2-month follow-up IVP showed marked improvement.