Ureteral involvement is rare, with an estimated frequency of 10–14% in cases of deep infiltrating endometriosis. An important complication of ureteral involvement is asymptomatic loss of renal function. We reported that a 49-year-old woman presented with chronic pelvic pain due to severe dysmenorrhea and without any urological symptoms. Magnetic resonance imaging (MRI) identified a 7 cm endometrioma compressing and infiltrating the rectal wall, and chronic left hydronephrosis. Isotope renogram decreased 14% function in the left kidney. We performed adhesiolysis, freeing of the uterus and appendages, hysterectomy, bilateral oophorectomy. However, we performed only to resect a part of left deep infiltrating endometriosis with ureteral involvement to avoid ureteral injury. After surgery, hydronephrosis was improved and those endometriosis left was not enlarged after 1 years of follow-up. We have to consider bilateral oophorectomy since endometriosis develops by the estrogen-dependent and it may decrease reproductive hormone derived from ovary.
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