Rritidr Jorrrnd of‘ Urology ( I 976). 48. 38
Short Case Report
It is of interest that Dick r t ul. (1973) recorded a case of endometriosis involving the ureter in a post-menopausal wom;in in which the disease was reactivated by the administration of a synthetic oestrogen resulting in ureteric obstruction.
Abeshouse and Abeshouse (1960) reviewed the literature on endometriosis of the urinary tract and could find only 15 cases of endometriosis of the ureter. The lesion can be “extrinsic”, that is to say, that masses of endometriosis constrict the ureter so that when it is freed from the mass it returns to normal, or it can be “intrinsic” where the ureter is actually invaded by theendometriosis.
STANLEY WAYand J. R . YOUNG, Departtnents of GjvaecoloKical O r i c o l o ~ atid ~ ~ , Diagnostic Radiology, Queen Elizahetlr Ho.vpi/nl. Gatidrwtl
A SO-year-old pre-menopausal married woman was seen in September 1974 complaining of ( a ) postcoital bleeding for 6 months and (0) menorrhagia ;ind nietrorrhagia of 2 months’ duration. Vaginal examination revealed a carcinoma of the cervix which it was decided to treat by a combination of radium and surgery. On 25 September an excretion urogram revealed ;I normal left urinary tract but the right urinary tract showed dilatation of the pelvicalyceal system and ureter down to the level of the brim of the pelvis. Radium was applied to the cervix. At laparotoniy on 4 December, 1974 for radical hysterectomy and node dissection, an area of endometriosis. the size of a pinhead, was found on the anterior surface of the left broad ligament adjacent to the round ligament. On the right side of the pelvis, on the posterior peritoneum, over the right uterosacral ligament, near to its junction with the rectum and at the brim of the pelvis, there were 3 very small areas of endometriosis and, underlying this in the connective tissue, was an area of endometriosis, approximately 1.2 cm in diameter. On dissection, this was found to extend to the right ureter and to invade its outer coats obviously causing the stricture shown on the urogram. Even when the ureter had been completely freed, the stricture remained, due to the fact that the endometriosis was perforating the wall of the ureter. The ureter below the stricture was normal in size. There was no evidence of malignant involvement of the ureter. The histological appearances of the endometriosis removed from the ureter are shown in the Figure. As both ovaries were to be removed as part of the radical hysterectomy, it was decided to wait and see if the endometriosis subsided after operation. I5 weeks later an excretion urogram showed a normal urinary tract on both sides.
ABESHOUSE, B. S . and ABESHOUSE, G . (1960). tndonietriosis of the urinary tract: a review of the literature. Jortrnal 01- the Internu/iotiu/ C‘ollogcj of’ Sl/rgeoti.Y,83, 100-102. D I C K , A . L., LANG, D. W., B E R O M A N . R . T . . R119TNAGHAR, B. N . S. and S m v A m i , J. F. P. (1973). Postmenopausal endonietriosis with uretcric obstruction. Briti.dr Jorrmul o/’ Uro/og.v, 45, 153155.
Comment This case is an example of “intrinsic” endometriosis of the ureter. 38