What is Ureteral Endometriosis?
Ureteral endometriosis is a form of deep infiltrating disease where endometrial-like tissue invades the ureters—the thin, delicate tubes that carry urine from the kidneys to the bladder. This is a serious condition that requires urgent and expert management, as the disease can silently threaten the function of your kidneys.
There are two primary ways the disease affects the ureter:
Extrinsic Compression: Endometriotic nodules or heavy scar tissue outside the ureter “kink” or squeeze the tube, obstructing urine flow.
Intrinsic Infiltration: The disease grows directly into the wall of the ureter, causing internal narrowing (strictures) that can lead to hydronephrosis—a dangerous swelling of the kidney caused by urine back-pressure.
Because the ureters are buried deep in the retroperitoneal space and are located in close proximity to major pelvic nerves and blood vessels, ureteral endometriosis is one of the most technically demanding conditions to treat. It is frequently misdiagnosed as simple bladder issues or kidney stones until the damage to the kidney has already begun.
The most common symptoms
Symptoms of ureteral involvement are often subtle and can be easily confused with general urinary tract issues or period-related pelvic pain.
Flank and Kidney Pain
Patients often experience a deep, dull ache in the “flank”—the area on the side of the mid-back, between the ribs and the hip. This pain often becomes more pronounced during menstruation. It is a sign that the ureter is obstructed, causing urine to “back up” into the kidney. This is a critical symptom that should never be ignored.
Cyclical Urinary Changes
While many people have frequency or urgency during their period, ureteral endometriosis often causes more specific discomfort, such as a sharp, localized pain when the bladder is filling or an intense urge to urinate that does not result in relief. Some patients report hematuria (blood in the urine) during their menstrual cycle, which is a rare but highly specific sign that endometriosis has infiltrated the urinary tract.
Silent Kidney Damage
The most dangerous aspect of this condition is that it can be asymptomatic. The ureter can become significantly narrowed, and the kidney can begin to swell without causing noticeable pain. This is why we perform a comprehensive "map" of the entire retroperitoneal space during our surgical planning; we cannot rely on pain levels alone to gauge the severity of ureteral involvement.
Treatment Approach
Our Surgical Philosophy: Precision Ureteral Preservation
At ESSI, our philosophy regarding the ureter is “safety first, function always.” Treating ureteral endometriosis requires an elite level of surgical precision. We perform Laparoscopic Ureterolysis—a delicate process where we identify the ureter, carefully trace its path through the diseased tissue, and meticulously peel the endometriosis away from the ureteral wall.
Because the ureter is a dynamic, living structure, our high-volume specialists use specialized magnification to identify the tiny blood vessels that supply the ureter itself. We work with extreme caution to preserve this blood supply, ensuring that the ureter remains healthy and functional after the disease is removed.
In cases of intrinsic infiltration, where the disease has grown inside the wall, our multidisciplinary team is prepared to perform a segmental resection—removing the diseased portion of the ureter and rejoining the healthy ends (anastomosis)—to fully restore urinary flow. Our goal is to protect your kidneys, prevent the need for stents or catheters, and eliminate the pelvic pain that has hindered your life.
BOWEL Endometriosis
Frequently Asked Questions
1. Is ureteral endometriosis always a sign of Stage 4 disease?
Generally, yes. Ureteral involvement is a hallmark of deep infiltrating endometriosis (DIE) that has spread to the pelvic sidewalls and the retroperitoneum. Because the ureters are located deep in the pelvis, the disease must be quite advanced to reach and penetrate these structures. This is why our surgical approach is comprehensive; we treat the ureter while simultaneously addressing all other pelvic disease to ensure the best possible long-term outcome.
2. How do you detect ureteral disease if it’s silent?
Standard ultrasounds rarely show ureteral strictures. We utilize advanced, specialized imaging protocols, such as MRI with a specific focus on the retroperitoneum or CT urography, to "map" the ureters before surgery. During the procedure, we perform a systematic visual and tactile exploration of the retroperitoneal space. We do not just look at the pelvic organs; we surgically expose the ureters to ensure they are free of disease, which is the only way to be 100% certain.
3. Will I need a permanent kidney stent after surgery?
Our absolute priority is to avoid the need for permanent stents. In the vast majority of cases, meticulous ureterolysis—the complete, gentle removal of the disease from the ureter—is all that is required to restore normal function. If a resection is necessary, we use microsurgical techniques to reconstruct the ureter so it can function independently. We only use temporary stents if needed to assist the healing process immediately following a complex reconstruction, with the goal of removing them as soon as the tissue has safely healed.