Endometriosis of the ureteral stump: An entity with severe manifestations

A 50-year-old woman on continuous oral estroprogestin therapy and with a history of endometriosis presented with gross hematuria and right reno-ureteral colic pain. Fifteen years before she had undergone total nephrectomy for loss of function of her right kidney due to an ureteral endometriotic nodule resulting in ureteral obstruction. The ureter had not been removed. For the following 15 years-period she had not manifested symptoms or signs of endometriosis. Although imaging investigations allowed to suspect endometriosis of the ureteral stump, urothelial cancer or carcinoma arising in endometriosis nodule could not be excluded. A laparoscopic hysterosalpingo- oophorectomy with the residual ureteral stump removal was performed. Some endometriotic implants on the ureteral stump wall were histologically detected. Proximal ureterectomy should be recommended in patients affected by ureteral endometriosis with a non-functioning kidney since long-term severe complications could derive from the residual stump. A continuous estroprogestin therapy does not totally prevent these complications.