Dyschezia and the ureters
Unfortunately, endometriosis invasion of the ureters is often
asymptomatic or presents with nonspecific symptoms (21), which can lead
to silent, obstructive uropathy and renal failure, with a high rate of
kidney loss (23–47%) (22).
To detect ureteric involvement, an MRI is the first choice diagnostic
tool (21), while it allows proper evaluation of the whole pelvis and
helps to decide the surgical approach. In our study we found that
dyschezia has a predictive value in detecting ureteric involvement. From
an anatomical point of view this can easily be explained, an
endometriosis nodule in, or close to the rectum (which causes dyschezia)
can also involve or press against the ureter. Translating our research
evidence to clinical practice: if endometriosis patients report
dyschezia (NRS>6.5), the clinician should be aware of
possible ureteric involvement and extend the transvaginal ultrasound
with a mandatory MRI (pelvis with kidneys) or at least an ultrasound of
the kidneys/ureters.