Laparoscopic management of ureteral endometriosis: our experience.

STUDY OBJECTIVE: Ureteral endometriosis is rare, accounting for less than 0.3% of all endometriotic lesions. The aim of our study is to evaluate the prevalence of extrinsic ureteral endometriosis in women undergoing laparoscopic surgery for severe endometriosis and to suggest that laparoscopic ureterolysis represents a mandatory measure in all cases to avoid ureteral injury. METHODS: A retrospective analysis was performed of all cases of patients who underwent laparoscopic surgery for severe endometriosis at the departments of obstetrics and gynecology at CMCO-SIHCUS and Hautepierre Hospital, Strasbourg, from November 2004 through January 2006. MEASUREMENTS AND MAIN RESULTS: We recorded 54 patients with a mean age of 31 years and a mean body mass index of 21.9. Reported symptoms were dysmenorrhea (88%), severe dyspareunia (88%), severe pelvic pain (38.8%), and infertility (74%). Five women presented with dysuria, frequency, recurrent urinary tract infections, and pain in the renal angle, and 2 patients had hydronephrosis. We observed 3 patients (5.6%) with ureteral stenosis, 35 (64.8%) with adenomyotic tissue surrounding the ureter without stenosis, and 16 (29.6%) with adenomyotic tissue adjacent to the ureter. It was on the left side in 47.4% of cases, on the right side in 31.6% cases, and bilaterally in 21% of cases. In 9 patients, ureteral involvement was associated with bladder endometriosis (16.7%). In all patients, ureterolysis was performed. There was 1 case of ureteral injury during the procedure, 2 of transitory urinary retention, and 1 of uretero-vaginal fistula after surgery. During the first year of follow-up, the disease recurred in 4 patients, with no evidence of the disease in the urinary tract. CONCLUSION: Conservative laparoscopic surgery to relieve ureteral obstruction and remove pathologic tissue is the management of choice. Resection of part of the ureter should be performed only in exceptional cases. Ureterolysis should be performed in all patients before endometriotic nodule resection to recognize and prevent any ureteral damage.

Disseminated intravascular coagulation after laparoscopic multiple myomectomy with use of icodextrin: a case report.

Uterine leiomyomas are by far the most common benign genital tumors. The prevalence rates vary from 20% to 50%. Myomectomy is a standard surgical treatment and is prescribed for patients who wish to preserve their fertility. The laparoscopic approach allows a shorter hospital stay, faster recovery, less intraoperative blood loss, less postoperative pain, and possibly fewer adhesions than abdominal myomectomy when performed by skilled surgeons. Myomectomy is associated with the risk of excessive blood loss and adhesions formation. Reports of disseminated intravascular coagulation complicating this type of surgery are rare, and no prior cases have been reported in the literature after the use of 4% icodextrin. Randomized trials support the use of absorbable adhesion barriers to reduce adhesion formation. A case of disseminated intravascular coagulation after laparoscopic multiple myomectomy with the use of 4% icodextrin solution is described.