Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis.

Ureteral or vesical endometriotic lesions affect about 1% of women with endometriosis. The diagnosis may be difficult when specific symptoms are lacking. A delay in diagnosis can lead to significant morbidity. An adequate comprehension of the circumstances in which ureteral and vesical endometriosis present or should be suspected, aided by advances in imaging techniques and laparoscopic surgery, may allow a significant progress in the treatment of these conditions. The pathogenesis, diagnosis, and treatment of ureteral and vesical endometriosis are reviewed, with the aim of increasing the degree of awareness of the clinicians and helping in devising an adequate clinical management plan for the lesser understood aspects of the disease.

Bladder psoas hitch in hydronephrosis due to pelvic endometriosis: outcome of urodynamic parameters.

OBJECTIVE: To evaluate modifications in bladder sensitivity and function after ureteroneocystostomy with bladder psoas hitch for hydronephrosis due to deep pelvic endometriosis. DESIGN: Prospective study. SETTING: Center for the Treatment of Endometriosis of the Department of Obstetrics and Gynecology of the State University of Milan, Italy. PATIENT(S): Thirteen patients with deep endometriosis and ureteral involvement. Mean age of patients was 36.8 years (range, 31-48 years). INTERVENTION(S): Ureteroneocystostomy with a psoas hitch. Indications for performing psoas hitch ureteroneocystostomy were severe hydronephrosis, radiologic evidence of ureteral stricture measuring >4 cm, and the impossibility of performing ureterolysis. MAIN OUTCOME MEASURE(S): Impact on urodynamic parameters of bladder psoas hitch ureteroneocystostomy. RESULT(S): All patients showed normal bladder capacity 3 months after surgery. Two patients presented with stress incontinence immediately after surgery, which almost completely subsided at 3 months' follow-up. In 4 patients the bladder was also involved; in these cases a bladder resection was performed, followed by ureteral reimplantation. Follow-up was at 6 months from surgery and then every 6 months thereafter, in which patients underwent urogynecologic examination, completed a questionnaire on urinary symptoms, and underwent renal ultrasound evaluation with no evidence of recurrence of obstructive uropathy. CONCLUSION(S): On the basis of the results of the present study, bladder psoas hitch along with ureteral resection and ureteroneocystostomy for infiltrating endometriosis do not seem to have a negative impact on urodynamic parameters.

Prevalence of anal incontinence in women with symptoms of urinary incontinence and genital prolapse.

OBJECTIVE: To investigate risk factors and prevalence of anal incontinence among women with pelvic floor dysfunctions. METHODS: We evaluated 881 women with symptoms of urinary incontinence and/or genital prolapse. Each completed a bowel questionnaire and underwent a detailed medical, surgical, obstetric, and gynecologic history, and a pelvic examination. Additional testing, when indicated, included office cystometry or multichannel urodynamic evaluation. Multivariable analysis using logistic regression was used to test the overall significance of all variables significantly associated with anal incontinence, using univariate analysis. RESULTS: A total of 178 women had anal incontinence (20%). These patients were on average older, had a greater body mass index, and had larger birth weight infants than their anal-continent counterparts; 511 were diagnosed with urinary incontinence, and 122 (24%) also had anal incontinence. Women with urinary incontinence were more likely to report anal incontinence events than women continent of urine (24% versus 15%, P =.002). The following associations were found with anal incontinence: infant with birth weight 3800 g or greater (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1, 2.2), rectocele greater than grade 2 (OR 1.9, 95% CI 1.1, 3.3), urinary incontinence (OR 1.9, 95% CI 1.3, 2.8), hemorrhoidectomy (OR 2.7, 95% CI 1.1, 7.0), irritable bowel syndrome (OR 6.3, 95% CI 3.5, 11.5). CONCLUSION: Among women with symptoms of urinary incontinence and pelvic organ prolapse, the prevalence of anal incontinence was 20%. Urinary incontinence and severe rectocele were found to be associated with anal incontinence.