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.