Deep endometriosis can also reach the ureters, especially in case of rectal lesions of more than 3 cm in size, lesions lateralized to the uterine perimetrium or sub-ovarian lesions(13, 15).
Ureter can be affected superficially or severely, with alterations to their course or even stenosis. This can impede the flow of urine, potentially leading to dilation of the ureter and stagnation of urine in the kidney, with possible loss of renal function. It is therefore vital to react quickly in case of ureteral distention to ensure that renal function is maintained by emergency placement of a JJ catheter to protect the adjoining kidney(13, 15).
Most lesions of the ureter (90%) are extrinsic, meaning that the entire ureter is preserved. In this case, the philosophy of the CEC remains faithful to the preservation of the organ: the ureter is then freed and the use of the CO2 laser in this precise procedure is essential in order to preserve the organ. In case of intrinsic ureteral injury (10%), it is necessary to resect part of the ureter. An end-to-end suture is then performed. If the resection is more important, it is necessary to reimplant the ureter in the bladder. This last procedure is performed by a team of urologists specialized in robotic surgery. Although this surgery is currently well mastered, there is still a risk of recurrent urinary tract infections or stenosis, which is why the CEC team only offers it in very specific indications in multidisciplinary consultation with the urology team.