Ureteral endometriosis post-hysterectomy for adenomyosis: a case report and literature review

Abstract

Objective: To explore the necessity of long-term pharmacological management following total hysterectomy for adenomyosis. Methods: A case of ureteral endometriosis identified over one year after laparoscopic total hysterectomy and bilateral salpingectomy for adenomyosis was retrospectively analyzed. Clinical data were reviewed, and related literature was summarized for discussion. Results: The patient underwent laparoscopic total hysterectomy and bilateral salpingectomy at our hospital more than one year prior because of adenomyosis. No pharmacological treatment was provided postsurgery. One year later, the patient presented with right lumbar discomfort. Imaging revealed hydronephrosis of the right kidney and dilation of the right ureter, leading to a diagnosis of right ureteral endometriosis. Laparoscopic excision of the ureteral endometriotic lesion was performed. Pathology confirmed right ureteral endometriosis with glandular cystic expansion. Postsurgery, the patient was treated with gonadotropin-releasing hormone agonist (GnRH-a) therapy (3.6 mg of goserelin via subcutaneous injection every 28 days for a total of six cycles). Treatment is ongoing. Follow-up ultrasound revealed no abnormalities in the kidneys or ureters, and no recurrence was observed during the five months of follow-up. Conclusion: Adenomyosis is often associated with deep endometriosis. Even if no evident deep pelvic endometriosis is identified during total hysterectomy, long-term pharmacological management postsurgery may still be necessary. This approach can reduce the incidence of deep endometriosis in organs such as the bladder, ureters, and intestines.