The ureter is the thin tubular structure that descends from the kidney across the groin to the bladder, where it empties urine through a tiny opening called the ureteric orifice. There are usually only two ureters (left and right), but in unusual situations some patients have two per side (duplex ureters).
Surgery for endometriosis is ALWAYS in very close proximity to this vital structure. It is Dr Gordon’s practice during all advanced pelvic laparoscopic surgeries to have the ureter safely identified so that no harm can ever occur.
Patients with endometriosis involving the pelvic side wall, and usually those with ovarian endometrioma cysts, will have a distortion of pelvic anatomy. The ureter may be involved in such surgeries, so it is important to ensure that it remains safe at all times. Photographs are often taken of the ureter during Dr Gordon’s surgeries, making it easy to understand the effect of scar tissue forming around the ureter.
The ureter can of course be obstructed by pelvic endometriosis; the long-term result is a reduction in kidney function on the side of the obstruction. Over 20 years, Dr Gordon has seen two patients with such severe untreated ureteric endometriosis who have each had a solitary kidney removed as a consequence of this pathology. Both patients have proceeded to live happy, healthy pain-free lives.