Ureteric Endometriosis and Ureteric Catheterisation

Ureteric Endometriosis and Ureteric Catheterisation – the ureter is the “tube” that takes urine from the kidney to the bladder.  Unfortunately, the ureter is located on the lateral pelvic side walls and very often lies in the vicinity of the ovary (directly under the ovary) or in some cases close to the uterosacral ligaments.  I personally call the ureter and “Endometriosis Magnet”.  If endometriosis involves either the ovary or the uterosacral ligament, then the adjacent underlying ureter may become affected or invaded by Endometriosis.  In rare cases the ureter may be partly blocked, so that the pain is felt in the kidneys as well as the pelvis. – In order to dissect Endometriosis from the peritoneum over the ureter, it is sometimes necessary to insert a plastic “ureteric catheter” into the ureter, to identify it.  This is done in the operating theatre by using a cystoscope (similar to a laparoscope) but much smaller in diameter.  The cystoscope is inserted into the bladder and the bladder is distended with fluid and the ureteric opening or orifice is identified.  The catheter is then carefully advanced up into the ureter.  The ureteric orifice or entrance into the bladder is identified as a small dimple or “slit”, often on top of a “dome”.  Urine can be seen being expelled into the bladder, if one waits a few minutes.

Once the operation has been finished, the catheter is removed from the bladder.

Laparoscopically the ureter (with the catheter inside) is clearly identified as a long tubular, plastic ureteric catheter inside it. 

Because of the amount of ooze often associated with this procedure, a soft drain is commonly inserted into the pelvic cavity, to allow any excessive blood to escape.  This drain is removed 1-2 days after the procedure.