Clinical features and long-term surgical outcomes of ureteral endometriosis with hydroureteronephrosis: a retrospective study

Tang X, Xinyue Tang, Gu Z, Zhiyue Gu, Dai Y, Yi Dai, Xiaoyan Li, Li X, Shiqing Lyu, Lyu S, Wu Y, YuShi Wu, Chenyu Zhang, Zhang C, Qiutong Li, Li Q, Hailan Yan, Yan H, Yuanyuan Li, Li Y, Shi J, Jinghua Shi, Shuangzheng Jia, Leng J, Jinhua Leng
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04664-z · PMID:42426747 · PMC13637158 · W7167804889
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This study compared surgical outcomes for ureteral endometriosis with hydroureteronephrosis, finding ureterolysis with nodule excision suitable for most cases while segmental ureterectomy was reserved for complex intrinsic lesions or previous surgical failures.

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This retrospective study evaluated the clinical features and long-term surgical outcomes of 74 patients with ureteral endometriosis complicated by hydroureonephrosis. The researchers compared postoperative results between those undergoing ureterolysis with nodule excision and those receiving segmental ureterectomy, noting that intrinsic lesions and prior surgery were associated with the latter approach. After a median follow-up of nine years, ureterolysis demonstrated acceptable efficacy with low recurrence rates, while segmental resection was reserved for more complex cases involving intrinsic disease or failed stenting. This paper is centrally about endometriosis — specifically the surgical management of deep infiltrating lesions affecting the ureters and causing hydronephrosis.

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Abstract

BACKGROUND: Ureteral endometriosis with hydroureteronephrosis can impair renal function, yet few clear guidelines exist for its surgical treatment. This study aimed to compare the clinicopathological features between patients undergoing ureterolysis with nodule excision versus segmental ureterectomy with anastomosis for ureteral endometriosis with hydroureteronephrosis, and to report the postoperative outcomes. METHODS: This retrospective study included 74 patients with ureteral endometriosis and hydroureteronephrosis who underwent surgery at a tertiary hospital between 2004 and 2024. Clinicopathological characteristics were compared between the ureterolysis and segmental ureterectomy groups using Student's t-test or Mann-Whitney U test for continuous variables, and the χ² test or Fisher's exact test for categorical variables. Variables with P < 0.05 on between-group comparisons were entered into a multivariable logistic regression analysis. Surgical outcomes, including recurrence of hydroureteronephrosis and ureteral complications, were reported. RESULTS: Among the 74 patients, 25.7% presented with urinary symptoms. All patients had additional pelvic endometriosis beyond ureteral involvement, including ovarian endometriomas (75.7%) and deep endometriosis at other sites (82.4%). Ureteral endometriosis was classified as extrinsic (82.4%) or intrinsic (17.6%). 54 (73%) patients underwent ureterolysis with nodule excision and 20 (27%) underwent segmental ureterectomy with anastomosis. All 13 intrinsic lesions underwent segmental ureterectomy (P < 0.001). Multivariable analysis revealed that previous endometriosis surgery (OR = 4.413; 95%CI: 1.138-17.108; P = 0.032) and preoperative failed Double-J stenting (OR = 7.833; 95%CI: 1.946-31.522; P = 0.004) were independently associated with the segmental ureterectomy. At a median follow-up of 9 years, the ureterolysis group had 7.4% recurrent hydroureteronephrosis and 1.9% ureteral fistula; the segmental ureterectomy group experienced no recurrent hydroureteronephrosis or ureteral complications. CONCLUSIONS: Ureteral endometriosis complicated by hydroureteronephrosis often lacks urinary symptoms, with only a minority of lesions classified as intrinsic subtypes, and is almost always accompanied by ovarian endometriomas or deep endometriosis at other pelvic sites. After careful patient selection, 73% of subjects underwent ureterolysis with nodule excision and demonstrated acceptable long-term outcomes. Segmental ureterectomy with anastomosis was reserved for refractory cases, such as patients with intrinsic ureteral lesions, a history of prior endometriosis surgery, or failed preoperative Double-J stenting.
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Abstract

Background Ureteral endometriosis with hydroureteronephrosis can impair renal function, yet few clear guidelines exist for its surgical treatment. This study aimed to compare the clinicopathological features between patients undergoing ureterolysis with nodule excision versus segmental ureterectomy with anastomosis for ureteral endometriosis with hydroureteronephrosis, and to report the postoperative outcomes.

Methods

This retrospective study included 74 patients with ureteral endometriosis and hydroureteronephrosis who underwent surgery at a tertiary hospital between 2004 and 2024. Clinicopathological characteristics were compared between the ureterolysis and segmental ureterectomy groups using Student’s t-test or Mann-Whitney U test for continuous variables, and the χ² test or Fisher’s exact test for categorical variables. Variables with P < 0.05 on between-group comparisons were entered into a multivariable logistic regression analysis. Surgical outcomes, including recurrence of hydroureteronephrosis and ureteral complications, were reported.

Results

Among the 74 patients, 25.7% presented with urinary symptoms. All patients had additional pelvic endometriosis beyond ureteral involvement, including ovarian endometriomas (75.7%) and deep endometriosis at other sites (82.4%). Ureteral endometriosis was classified as extrinsic (82.4%) or intrinsic (17.6%). 54 (73%) patients underwent ureterolysis with nodule excision and 20 (27%) underwent segmental ureterectomy with anastomosis. All 13 intrinsic lesions underwent segmental ureterectomy (P < 0.001). Multivariable analysis revealed that previous endometriosis surgery (OR = 4.413; 95%CI: 1.138–17.108; P = 0.032) and preoperative failed Double-J stenting (OR = 7.833; 95%CI: 1.946–31.522; P = 0.004) were independently associated with the segmental ureterectomy. At a median follow-up of 9 years, the ureterolysis group had 7.4% recurrent hydroureteronephrosis and 1.9% ureteral fistula; the segmental ureterectomy group experienced no recurrent hydroureteronephrosis or ureteral complications.

Conclusions

Ureteral endometriosis complicated by hydroureteronephrosis often lacks urinary symptoms, with only a minority of lesions classified as intrinsic subtypes, and is almost always accompanied by ovarian endometriomas or deep endometriosis at other pelvic sites. After careful patient selection, 73% of subjects underwent ureterolysis with nodule excision and demonstrated acceptable long-term outcomes. Segmental ureterectomy with anastomosis was reserved for refractory cases, such as patients with intrinsic ureteral lesions, a history of prior endometriosis surgery, or failed preoperative Double-J stenting. Similar content being viewed by others Abbreviations - UE: - Ureteral endometriosis - DE: - deep endometriosis - GnRHa: - Gonadotropin-Releasing Hormone Agonist - GFR: - glomerular filtration rate - OR: - odds ratio - CI: - confidence interval - ASRM: - American Society for Reproductive Medicine - MRI: - Magnetic Resonance Imaging

Acknowledgements

We are grateful to all the patients who participated in our study. Funding This study was funded by the National Key R&D Program of China (2022YFC2704000), the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-085), and the National Key Clinical Specialty Construction Project (Grant No. U114000). Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committee of Chinese Academy of Medical Sciences & Peking Union Medical College Hospital on 31 October 2023, approval number I-23PJ1807, in accordance with the Declaration of Helsinki. The study has been granted a waiver from requiring written informed consent by the Ethics Committee of Chinese Academy of Medical Sciences & Peking Union Medical College Hospital. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Tang, X., Gu, Z., Dai, Y. et al. Clinical features and long-term surgical outcomes of ureteral endometriosis with hydroureteronephrosis: a retrospective study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04664-z Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04664-z

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MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis Hydronephrosis

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