Urological Complications of Endometriosis: Why Specialist Care Matters

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it. While it is most often thought of as a gynaecological condition, endometriosis can affect many organs in the body — including the urinary tract.

When the bladder, ureters, or even kidneys are involved, the condition becomes not only painful but potentially dangerous. Early recognition and treatment are vital to prevent long-term damage, yet these complications are often overlooked.

At Dr MC Conradie Inc., we specialise in minimally invasive laparoscopic and robotic-assisted surgery and complex reconstructive urology. This unique combination of expertise ensures that women with urinary tract complications from endometriosis receive safe, precise, and effective treatment.

(Image Source: The Leeds Teaching Hospital, https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/)

How Endometriosis Affects the Urinary Tract

While less common than pelvic or ovarian involvement, urinary tract endometriosis can have serious consequences.

• Ureteric Endometriosis
  The ureters are the thin tubes that drain urine from the kidneys into the bladder. Endometriosis can narrow or obstruct these tubes, leading to back-pressure on the kidneys (hydronephrosis). If untreated, this can result in permanent kidney damage.
• Kidney Complications
  Because ureter obstruction may not cause immediate pain, kidney function can be silently lost. This makes timely diagnosis crucial.
• Pelvic Floor Involvement
  Chronic pelvic pain from endometriosis can also affect the pelvic floor muscles, leading to bladder dysfunction and overlapping urinary symptoms.
• Bladder Endometriosis
  Endometriotic tissue can invade the bladder wall, causing pain when urinating, urinary urgency, frequency, or even blood in the urine (often worse around menstruation).
• Surgery-Related Damage
  Surgery to remove deep endometriosis can itself damage the ureter. When this occurs, complex reconstructive surgery is needed to restore urinary flow and prevent long-term kidney injury.

Symptoms to Look Out For

Women with urinary tract endometriosis may experience:

• Painful urination (especially during menstruation)
• Blood in the urine
• Recurrent urinary tract infections without clear cause
• Flank pain or unexplained kidney issues
• Persistent bladder urgency or frequency

If you have these symptoms — particularly if they worsen around your menstrual cycle — it’s important to consult a specialist.

Diagnosis: Why It’s Often Missed

Urinary endometriosis can be difficult to diagnose, as its symptoms often mimic other conditions such as urinary tract infections or overactive bladder.

Investigations may include:

• Ultrasound or MRI scans to detect endometriotic nodules in the bladder or ureters.
• Cystoscopy (bladder camera) to identify lesions inside the bladder.
• Specialist urological evaluation to distinguish between gynaecological and urinary causes

Treatment Options

The right treatment depends on the severity and location of the disease.

• Medical management: Hormonal therapies can relieve symptoms but are often not enough for urinary tract involvement.
• Surgical treatment:
  • Laparoscopic or robotic-assisted excision of bladder or ureteric endometriosis
  • Partial cystectomy (removal of part of the bladder) when lesions are invasive
  • Ureteric reconstruction when strictures or damage occur
  • Ureter reimplantation in severe cases

With minimally invasive surgery, patients benefit from:

• Smaller incisions
• Less pain
• Faster recovery
• Excellent long-term outcomes

Distal Ureteral Strictures and the Boari Flap

One of the most challenging complications of urinary tract endometriosis — or surgery for endometriosis — is a distal ureteral stricture. This is a narrowing of the lower ureter near the bladder, which can obstruct urine flow and damage the kidney.

When the diseased portion of the ureter must be removed, a direct reconnection to the bladder is sometimes not possible due to the gap. In these cases, advanced reconstructive techniques are required.

The Boari Flap Technique

A Boari flap is a surgical procedure where a flap of bladder tissue is fashioned into a tube to replace or extend the ureter. This restores continuity between the kidney and bladder while preserving function.

Performed via laparoscopic or robotic-assisted approaches, the Boari flap allows:

• Precise reconstruction of the ureter
• Excellent preservation of kidney drainage
• Durable, long-term outcomes with reduced risk of stricture recurrence

This highly specialised operation requires expert endo-urology skills, and is not routinely performed outside of advanced urological centres.

(Image Source: Research Gate, https://www.researchgate.net/figure/Boari-flap-a-A-wide-based-flap-is-developed-by-an-anterior-bladder-wall-incision-b_fig3_260306551)

Why Specialist Urological Care Is Essential

Urinary complications of endometriosis are rare but potentially devastating. They demand not just surgical excision of endometriotic tissue, but also advanced reconstructive urology when the bladder or ureters are compromised.

Dr MC Conradie offers:

• Expertise in female pelvic floor medicine and urogynaecological reconstruction
• Advanced skills in laparoscopic and robotic-assisted urological surgery
• Proven experience in complex reconstructions like Boari flap procedures and ureter reimplantation

By combining advanced reconstructive and minimally invasive expertise, Dr Conradie provides comprehensive, patient-centred care that protects urinary function, relieves symptoms, and preserves long-term quality of life.

Endometriosis can cause more than pelvic pain — it may silently damage the urinary system, leading to bladder dysfunction or even kidney loss. When strictures or damage occur, advanced surgical reconstruction may be required.

With minimally invasive expertise and world-class reconstructive skills, Dr MC Conradie ensures women receive safe, effective treatment with optimal long-term outcomes. If you or your patient is experiencing urinary symptoms with suspected endometriosis, specialist evaluation could make all the difference. Contact Dr Conradie’s practice today for expert care.