Deep endometriosis can also affect the ureters, especially in the case of rectal lesions larger than 3cm, lesions lateralized to the uterine parameters or sub-ovarian lesions(13, 15).
The ureter may be affected superficially or severely, with alteration of its trajectory or even stenosis. In this case, the progression of urine becomes more difficult, which can lead to dilation of the ureter, with stagnation of urine in the kidney and possible consequent loss of renal function. In the event of ureteral dilation, it is therefore important to react quickly to ensure that renal function is maintained, with emergency insertion of a JJ catheter to protect the kidney(13, 15).
Most ureteral lesions (90%) are extrinsic, meaning that the entire ureter is preserved. In this case, the CEC philosophy 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 to preserve the organ. In the 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 extensive, the ureter needs to be re-implanted into the bladder. This last procedure is performed by a team of urologists specialized in robotic surgery. Although this type of surgery is now 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 consultation with the urology team.