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Monday, 8 June 2015

Endometriosis and kidney involvement

Endometriosis is a very common condition which may start early in life. It is thought to be an autoimmune disease but nobody really knows what the cause is. I had a 30 year old patient who started having painful and irregular periods from her teenage years. She had seen many gynaecologists over the years all of whom told her that she will grow out of the pains treating her with hormonal therapy. Unfortunately she did not 'grow out of her pains' but instead the painful periods worsened. She also started getting pain in her back where her right kidney was. When I saw this young lady she was also concerned that although she had been trying for a pregnancy for the last two years, nothing was happening and her in-laws were getting anxious. Mdm FKL had an ultrasound scan which then showed that she had ovarian cysts on both ovaries and they appeared to be stuck to back of the womb. As I suspected that she had endometriosis. I proceeded to do the full endometriosis work-up for her including an MRI of her pelvis and a hormonal profile. The MRI confirmed the endometriotic cysts and the adhesions. In addition there was a suggestion that the right kidney and urinary tract may be involved. MRI is now an important tool in the assessment of endometriosis as it will give the gynaecologist an indication of the extensiveness of the endometriosis. In this way he is not taken by surprise during surgery, and instead will have a well thought out plan to deal with the endometriosis prior to operation. Mdm FKL was referred to a urologist to assess the extent of the urinary tract involvement. The urologist was also there to insert stents into the ureters so as to aid in the operation. I then performed a laparoscopic key hole removal of the cysts and extensive freeing of all the adhesions so that the tissues were returned as best as possible to their original state. I am happy to say that Mdm FKL is now free of her pain and is now 6 weeks pregnant!
Extensive work-up prior to surgery is vitally important so as to get the best results. Planned well executed surgery is better than a haphazard approach and perhaps incomplete surgery which may result in the patient having to have further surgeries in the future.


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