European Journal of Obstetrics & Gynecology and Reproductive Biology
Full length articleClinical characteristics of urinary tract endometriosis: A one-year national series of 232 patients from 31 endometriosis expert centers (by the FRIENDS group)
Introduction
Deep infiltrating endometriosis (DIE) is defined as the infiltration by ectopic endometrial glands under the peritoneum for more than 5 mm. The most frequent locations are the retrocervical space, uterosacral ligaments, the ovaries, the bowel wall and the urinary tracts [1], [2]. Urinary tract endometriosis (UTE) is a rare location of the disease, which affects 1.2 to 6% of women [1], [2], [3], [4], [5]. The incidence increase in populations of patients undergoing surgery for DIE [6]. The bladder is usually reported as the most common location of UTE and may be present in up to 85% of cases [22,37]. The ureter is less often affected, with a prevalence ranging from 0.5 to 10% of UTE locations [7], [8]. Bladder endometriosis (BE) is responsible for symptoms of bladder irritation such as voiding dysfunction, polyuria, urgency, hematuria and urinary incontinence [9], [10], [11], [12], [13], [14], [15]. Symptoms appear to be related to the location and size of the nodule [16].
The definition of ureteral endometriosis (UE) remains controversial. According to Nezhat et al., extrinsic and intrinsic form of UE endometriosis should be differentiated. Intrinsic endometriosis, which is defined by the involvement of the ureter wall may affect up to 20% of patients with UTE [17]. Conversely, extrinsic UE is defined by an involvement of the ureter by an endometriosis nodule from adjacent structures [17]. The incidence and characteristics of this pathology remains difficult to evaluate.
The objective of this study was to perform a prospective review of the main characteristics of patients with UTE in France during a one year period.
Section snippets
Population of the study
We performed a multicentric prospective study on a population of patients managed surgically for deeply invasive UTE in France, from January 1, 2017 to December 31, 2017. All surgeons affiliated with the FRIENDS group (French coloRectal Infiltrating ENDometriosis Study group), were invited to prospectively and consecutively include all of their patients corresponding to the inclusions criteria, who underwent a surgery for UTE. The FRIEND group was founded in 2015 and consists of a network of
Population and patient’s characteristics
A total of 232 patients with UTE were included in our study from January 1, 2017 to December 31, 2017. Among the members of the FRIENDS group, 31 centers participated in the study, 23 (74.2%) were from University Hospitals and 8 (25.8%) from private structures. The median number of inclusions by department was 5 and varied between 1 and 27 patients.
Surgical history of endometriosis was reported in 76 patients (32.7%) which involved a urological location in 23 patients (9.9%). The patients with
Discussion
We report the results of a prospective longitudinal study, which included 232 patients managed surgically for UTE, in 31 French endometriosis center throughout the year 2017. To our knowledge, this is the second largest documented series of patients with UTE. Indeed, Ceccaroni et al recently reported a single center experience on 160 patients with UE and 264 patients with BE over a 10 years period [22], [23].
We report 82 patients (35.3%) with IBE, 126 (54.5%) with IUE and 24 (10.3%) with ML,
Conclusion
Our study describes the main clinical characteristic of urinary tract endometriosis patient in France, in 31 gynecological surgical departments over a one-year period. Schematically, we distinguished two different populations of patients with their own characteristics: Patients with UE are usually slightly older, often asymptomatic and present more frequently associated posterior DIE lesions. Conversely, BE is associated with specific urinary symptoms (polyuria, cystalgia, voiding dysfunction,
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
The authors would like to thank the following member of the FRIENDS group, who also participated to the study : C. CHAPRON, T. HEBERT, S. DOUVIER, L. FILIPUZZI, P. DESCAMPS, A. WATRELOT, A. AGOSTINI, J. BLANCHOT, C.M. ROGER, L. FRIEDERICH, P. COLLINET, P. VON THEOBALD, A. LETOHIC, M. MIMOUNI, A. MEPHON, T. GAUTHIER, N. HABIB, A. HOST, B.COTTE, R. RAMANAH, G. TRIOPON, F. GUILIBERT, F. AFCHIN,C. HOCKE, E.LAROUZEE, B.DOUSSET, A.PIVANO, E.BEAUVILLE, and B.RESCH. We also thank Mrs. Isabelle CAIN for
Ethical approval
After consulting independent ethics committee, no Institutional Review Board approval was required for this study.
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