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Case Reports in Urology
Volume 2013 (2013), Article ID 812475, 5 pages
http://dx.doi.org/10.1155/2013/812475
Case Report

Lumbar Ureteral Stenosis due to Endometriosis: Our Experience and Review of the Literature

1Unit of Urology, Department of Human Pathology, University of Messina, Via C. Valeria 1, 98125 Messina, Italy
2Unit of Gynecology and Obstetrics, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Via C. Valeria 1, 98125 Messina, Italy
3Unit of Pathological Anatomy, Department of Human Pathology, University of Messina, Via C. Valeria 1, 98125 Messina, Italy

Received 9 March 2013; Accepted 7 April 2013

Academic Editors: G. Lombardi and M. Marszalek

Copyright © 2013 Salvatore Butticè et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endometriosis is a chronic gynaecological disorder characterized by the presence of endometrial tissue outside the uterus. The disease most often affects the ovaries, uterine ligaments, fallopian tubes, and cervical-vaginal region. Urinary tract involvement is rare, accounting for around 1%-2% of all cases, of which 84% are in the bladder. We report a case of isolated lumbar ureteral stenosis due to endometriosis in a 37-year-old patient. The patient came to our observation complaining from lumbar back pain and presented with severe fever. The urological examination found monolateral left positive sign of Giordano. Blood tests evidenced marked lymphocytosis and increased valued of C-reactive protein. Urologic ultrasound showed hydronephrosis of first degree in the left kidney and absence of images related to stones bilaterally. Uro-CT scan evidenced ureteral stenosis at the transition between the iliac and pelvic tracts. We addressed the patient to surgery, and performed laparoscopic excision of the paraureteral bulk, endoscopic mechanical ureteral dilation, and stenting. The histological examination evidenced glandular structures lined by simple epithelium and surrounded by stroma. Immunohistochemical test of the glandular epithelium showed positivity for estrogen and progesterone receptors and moreover stromal cells were positive for CD10. The finding suggested a very rare diagnosis of isolated lumbar ureteral endometriosis.