Publication:

Deep-infiltrating endometriosis with primary presentation as obstructive uropathy: report of two cases

Endometriosis can have a broad spectrum of presentation and may sometimes affect/encase ureters leading to scarring, adhesion formation and obstruction resulting in backpressure changes in kidneys and ureters. Ureteral endometriosis is generally asymptomatic for long term. By the time symptoms arise, renal damage can be irreversible.  Two of our cases had an unusual presentation of flank pain, mimicking urological pathology. Both had obstructive uropathy without any of the typical gynecological features of endometriosis like dysmenorrhea, chronic pelvic pain or infertility. One had a unilateral nonfunctional kidney due to long standing hydroureteronephrosis, for which a nephrectomy was done. In other, obstructive uropathy was managed with bilateral percutaneous nephrostomy. Fertility-preserving surgery for endometriosis was done in both the cases. To conclude, endometriosis can have non-gynecological presentation also. So, in reproductive age females presenting with obstructive uropathy, endometriosis should always be kept as differential diagnosis. Endometriosis can be a silent killer for kidneys.