Unilateral obstructive uropathy caused by deep infiltrating endometriosis

Deep infiltrative endometriosis (DIE) is commonly associated with frozen pelvis, but rarely leads to silent obstructive uropathy. Herein, a case of unilateral hydronephrosis complicated by DIE is reported. A 43-year-old woman suffered low back pain, predominantly on the right, for one week. She had uterine fibroids as large as 14 weeks gestation in size. Upon ureteral catheterization for right hydronephrosis before hysterectomy, obstructive uropathy secondary to DIE involving in the distal third of the ureter adjacent to the uterosacral ligament was evident. Symptoms were immediately relieved by adhesiolysis. Following subcutaneous injection of a gonadotropin-releasing hormone analogue (Goserelin, 3.6 mg per month for 2 months) and removal of the intraureteral catheter after one month, the patient was free from ureteral obstruction. DIE-associated obstructive uropathy should be diagnosed early and prompt surgical intervention should be performed in order to avoid silent renal deficiency.