V01-12: Thulium Laser Coagulation of Residual Ureteral Endometriosis
Thulium laser coagulation of bleeding spots of endometriosis in left residual ureter in a patient underwent ureteral reimplantation
We present this case report of a 36-years-old woman suffering from deep infiltrating endometriosis since 2009. In the past medical history she had exploratory laparotomy for hemoperitoneum due to tubaric vasal haemorrage, toracoscopy and biopsy for pleural effusion and pneumothorax in 2009, appendicectomy, ureterolysis and left salpingectomy and a following left ureteral reimplantation with Leadbetter-Politano technique and psoas-hitch in 2011. Renal function was preserved, with no signs of hydroureteronephrosis during the annual renal ultrasounds. In May 2018 the patient underwent hormonal stimulation for ART with the following appearance of macrohematuria, refractory to conservative treatment. A flexible cystoscopy and a semirigid ureteroscopy was performed with the evidence of a endometrial bleeding spot in the left residual ureter.
The latter was controlled with thulium laser coagulation (fiber 272 micron, 15W) of the lesion with an immediate resolution of haematuria. Pre-operative hemoglobine was 13,5 g/dl and after surgery was 12,7 g/dl. No bladder irrigation was required post-operatively. Urinary catheter was removed on the first postoperative day and the patient was discharged the same day. No further episodes of macrohematuria occurred during the six-months of follow-up.
Thulium laser can succesfully coagulate bleeding spots in residual ureteral tissue.