Design: Retrospective literature review of 141 select articles from January 1976 to March 2023

Setting: n/a

Patients or Participants: UE articles from Medline, PubMed, Ovid, Embase, MEDLINE, Cochrane review

Interventions: n/a

Measurements and Main Results:

UE is prevalent in 0.3-12% of all endometriosis cases and 19-53% of deep infiltrating endometriosis. Bladder endometriosis is the most common (80-85%) and has specific symptoms, most frequently dysuria and hematuria. Ultrasound (US) and magnetic resonance imaging (MRI) have reported sensitivities of 50-89% and 67-100%, and specificities of 98-100% and 83-100%. Other imaging modalities include computed tomography urogram (CTU) and cystoscopy, with reported sensitivities of 46% and 58% and specificities of 98% and 97%. Ureteral endometriosis is the second most common (9-23%) with non-specific symptoms. It is up to 50% asymptomatic and often complicated with hydronephrosis. US and MRI have reported sensitivities of 50-97% and 33-87%, and specificities of 95-100% and 98-100%. CTU has a less diagnostic value, with reported sensitivity and specificity of 36-57% and 76-89% for left ureter, and 18-60% and 70-88% for right ureter. Renal (<1-2%) and urethral (<1-2%) endometriosis are less prevalent with less available data. Limited case reports describe imaging findings of renal endometriosis often misinterpreted as renal tumors and urethral endometriosis has been misdiagnosed as urethral diverticulum. Endoscopic visualization with biopsy confirmation remains the diagnostic gold standard. Medical management consists of hormonal treatment and surgical procedures are based on disease location and associated complications. Surgical management leads to more definitive treatment with low complication rates. Current data supports a minimally invasive surgical approach.

Conclusion: Most suitable diagnostic modalities to detect UE are MRI, US, and cystoscopy. Minimally Invasive Surgery excision of UE with high clinical index of suspicion in multidisciplinary setting is gold standard for early surveillance detection, and leading to definitive treatment with excellent outcomes.