Risk Factors for Irreversible Unilateral Loss of Renal Function in Patients With Deep Endometriosis

Abstract

Abstract Background: Deep endometriosis (DE) is usually associated with severe pelvic pain, dysmenorrhea and other pain symptoms and can be more aggressive than other types of endometriosis, even leading to irreversible severe complications such as complete unilateral loss of renal function. Previous data showed that up to 30% of patients with urinary tract DE may have reduced kidney function at the time of diagnosis although the real prevalence is unknown. All doctors and health caregivers involved in endometriosis diagnosis and treatment should be aware of this complication and should suspect and avoid this rare, albeit severe, form of the disease. We aimed to describe the clinical and radiologic characteristics of deep endometriosis (DE) patients diagnosed with irreversible unilateral loss of renal function due to unilateral ureteral stenosis and evaluate risk factors for developing this loss. Methods: Retrospective cohort study including 436 patients who underwent laparoscopic DE surgery. We evaluated two groups of patients according to preserved (Non-Renal Loss Group; n=421) or irreversible unilateral damaged renal function (Renal Loss Group; n=15). Preoperative epidemiologic variables, clinical characteristics, radiologic findings and surgical treatments of all patients were collected. Results: The Renal Loss Group had a higher infertility rate and a higher proportion of asymptomatic patients. The following radiological variables showed statistically significant differences between the two groups: mean endometrioma diameter, the presence of intestinal DE and negative sliding sign. Multivariate analysis showed that infertility, being asymptomatic, having intestinal DE or torus uterinus/uterosacral ligament DE and a negative sliding sign significantly increased the risk of loss of renal function. Conclusions: Some clinical and radiological variables may help identify patients with DE at high risk of presenting loss of renal function due to ureteral stenosis. Therefore, among these patients, severe urinary tract obstruction should be specifically ruled out.