R B Nerli

Abstract

Introduction: Ureteral endometriosis is a rare disease affecting women of childbearing age, which presents with nonspecific symptoms and may lead to severe morbidity. The ureters can be involved either extrinsically and/or intrinsically by endometriosis. In this study we have retrospectively assessed the patients presenting to us with ureteral endometriosis. Materials and Methods: Between July 2009 and December 2019, (17) women of childbearing age presented to the urological services of the hospital with complaints of lower abdominal pain, dysmenorrhea, dysuria and a range of other symptoms. Results: Pain in lower abdomen was the most common symptom and was cyclical in the majority of the patients. Only 2 patients had undergone surgery (diagnostic laparoscopy) previously for pain in abdomen and normal ultrasonography. Conclusions: Ureteric endometriosis is rare but a cause of severe morbidity in those that have deep infiltrating endometriosis. Can lead to ureteric obstruction and at times loss of function. An index of suspicion in women in child bearing age is important. Hormonal manipulation along with surgical intervention is beneficial in most patients. Keywords: Ureteral endometriosis, Ureterolysis, Ureteroureterostomy, Ureteroneocystotomy, Nephroureterectomy, Endometriosis, Laparoscopic surgery.

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Abstract

Introduction: Angiomyolipoma (AML) is a benign neoplasm and consists of thick-walled poorly organized blood vessels, smooth muscle, and varying levels of mature adipose tissue. We evaluated the impact of clinical characteristics, particularly tumor diameter, and surgical treatment in the form of partial nephrectomy on the outcome of sporadic renal AML. Materials and Methods: Patients undergoing partial nephrectomy during the period Jan 2000 to Dec 2016 with a final diagnosis of angiomyolipoma formed the study group. Patient demographic data was collected, and data from during and after surgery was also reviewed. Results: The median age of the patients was 51 (38-55) years. At presentation, most patients were asymptomatic (6/8, 75%) with the AML presenting as an incidental finding on imaging done for other reasons. There was classical triphasic AML, consisting of elements of adipose tissue, smooth muscle and abnormal blood vessels, in 5/10 tumours (50%). The more aggressive epitheliod variant AML was present in 2/10 (20%). The median follow-up of the patients was 38 (29-64) months. During the follow-up period one (12.5%) patient who had two lesions progressively showed evidence of rising creatinine and decreasing creatinine clearance. Conclusions: AML is a benign renal neoplasm and should be treated initially conservatively. Surgical intervention when required should be nephron sparing so as to reduce the incidence of perioperative complications, loss of renal units, and development of CKD. Keywords: Angiomyolipoma, Nephron sparing surgery, Renal mass.

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