leuprolide and Ureteral-Obstruction

It is estimated that 1% of patients with endometriosis have involvement of the urinary tract, with the bladder being the most common location. Ureteral endometriosis is a rare entity, and the majority of cases are found at exploratory laparotomy for extensive involvement of the pelvic organs. Obstruction of the ureter may be caused by extrinsic or intrinsic disease, with the extrinsic form occurring four times as often. Progressive ureteral obstruction can be insidious in onset and ultimately lead to renal failure. Hormone therapy has had variable success, and open surgery has been the mainstay of treatment. Only one case of ureteral endometriosis, both intrinsic and extrinsic, diagnosed at ureteroscopy has been reported previously. We present a case of ureteral obstruction secondary to isolated intrinsic endometriosis diagnosed at ureteroscopy and treated endoscopically with holmium laser ablation and leuprolide therapy.

Topics: Antineoplastic Agents, Hormonal; Endometriosis; Endoscopy; Female; Humans; Leuprolide; Middle Aged; Radiography; Stents; Ureter; Ureteral Diseases; Ureteral Obstruction

Ureteral obstruction due to endometriosis is an infrequent condition which can be asymptomatic for a long time. Irreversible loss of renal function may result in cases with delayed diagnosis. Our report concerns a case of unilateral hydronephrosis and hypertension due to retroperitoneal endometriosis occurring in a 24-year-old woman. The management of patients bearing obstructive uropathy caused by endometriosis is discussed. In the present case, a conservative operation followed by medical treatment, including GnRH analogs, was used to preserve reproductive capacity.

Topics: Adult; Antineoplastic Agents, Hormonal; Chemotherapy, Adjuvant; Contraceptives, Oral, Synthetic; Desogestrel; Endometriosis; Estradiol Congeners; Ethinyl Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Hydronephrosis; Hypertension, Renal; Leuprolide; Retroperitoneal Space; Ureteral Obstruction

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.

Topics: Adult; Fallopian Tubes; Female; Humans; Incidence; Leuprolide; Ovariectomy; Ovary; Postoperative Complications; Syndrome; Ureteral Obstruction

Endometriotic ureteral obstruction is a serious event commonly diagnosed late and therefore associated with a major risk of hydronephrotic renal atrophy. The standard therapy is surgical. However, medical treatment has been reported using danazol, progestins, and estrogen-progestin combinations, although solid documentation of the effect of hormonal therapy against ureteral endometriosis is lacking. Gonadotropin-releasing hormone (GnRH) agonist treatment of endometriosis has yielded good results but has not been adequately reported in patients with ureteric involvement. We report three patients treated with a GnRH agonist, leuprolide acetate, for 6-9 months as a preoperative course. One patient had bilateral and two had unilateral obstruction. The preoperative course relieved the obstruction in the patient with bilateral disease and in one with unilateral changes. The failure occurred in a patient with intrinsic ureteric endometriosis. This early experience suggests a place for GnRH agonist therapy for patients with ureteric obstruction due to endometriosis, probably, but not necessarily, in conjunction with a planned surgical procedure. If medical therapy is attempted, close surveillance of renal function is mandatory.

Topics: Adult; Antineoplastic Agents; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Hydronephrosis; Leuprolide; Middle Aged; Pelvic Neoplasms; Radiography; Ureteral Neoplasms; Ureteral Obstruction