This video presentation follows a case of a patient with stage IV endometriosis causing ureteric stricture and hydroureter.

Design:

Case presentation and surgical video outlining the steps taken during the surgery.

Setting:

Sydney, Australia

Patients or Participants:

41-year-old G2P0 referred in with endometriosis-suspected secondary infertility.

A pelvic ultrasound which showed retroverted uterus, 3cm subserosal fibroid, normal regular endometrium, L ovary adherent to posterior uterus with 3cm endometrioma and multi-loculated fluid suggestive of adhesions.

She was counselled and booked and consented for laparoscopic excision of endometriosis + hysteroscopy D&C + tubal dye studies

Intraoperative findings showed stage IV endometriosis with large multifibroid uterus, obliterated pouch of douglas, endometrioma and L ovary adherent to posterior uterus and occupying pouch of douglas, rectum adherent to uterus, appendix adherent to uterus and R pelvic side wall, right hydro-ureter due to obstruction below pelvic brim and ovarian fossa. In light of findings, surgery was postponed for further imaging and renal function tests

Interventions:

An MRI pelvis showed left hydrosalpinx, L ovarian 22x34mm endometrioma, 39x54mm ?right ovarian endometrioma fibrotic mass adherent and compressing right ureter, recto-uterine cervical 35x26x30mm lesion, bilateral thickened uterosacral ligaments, normal anterior rectum.

Measurements and Main Results:

Patient was urgently seen by colorectal surgeon as well as a urologist and she was underwent a joint procedure with the three specialties - robotic + excision of severe endometriosis +/- bowel surgery + cystoscopy and ureteric stents.

Conclusion:

She had an uncomplicated post-operative course and was seen 6 weeks later and was doing well.