What the Urinary Tract Does - the rest of the Story
The physiology of the human body involves a process called homeostasis—that is, keeping all of the chemical processes balanced that constitutes a healthy life. Since the intake of what is needed—food, water, light, etc.—are converted back and forth into useful substances, homeostasis is not simply a matter of burning fuel to run everything. Instead, it’s a total summation of chemical reactions with intermediary products that participate in further chemical reactions. For example, proteins are important for the structure of body tissues, enzymes, and even antibodies, yet to be used as such must be converted from sources of nitrogen into large molecules and amino acids. The point being made here is that there are always things left over in the process.
Proteins are just one such version of the biochemistry in the human body, with hundreds of thousands of similar processes going on simultaneously. That’s a lot of leftovers, and our intestinal and urinary tracts are the ways we get rid of these leftovers, called excretion. Some of the leftovers, such as excess water, are harmless; others can be toxic if not excreted. The bowels pass out all of the leftovers from food ingested, after the body has sifted from it what is needed.
In other words, you really are not what you eat, but what you keep.
Ureters—the kidney off-ramps.
The kidneys take this process to a whole higher level of sophistication, passively filtering out waste but also actively excreting or re-absorbing substances that ensure homeostasis. The kidneys are the housekeepers for the chemistry lab that we each are. From the kidneys, this waste—urine—is passed down to the bladder by a pair of bilateral tubes called ureters. Ureters, like the bowel, have rhythmic undulations, and these movements “milk” the urine toward the bladder.
How does urinary tract function relate to endometriosis?
Endometriosis is when the glandular structures like that of the lining of the uterus—designed to be discarded into the outside world with each period—are pushed the wrong way through the tubes to drip into the pelvis, among other theoretical causes. Since this irritating tissue is therefore retained, not discarded, it can remain to cause intermittent, hormonally-stimulated areas of inflammation that scar; it also provokes the abdominal defense mechanisms that act to wall it off—causing “adhesions”—that is, tissue sticking to tissue which was intended to be floating freely. Endometriosis tissue can also accrue into a mass sizeable enough to obstruct things that normally want to remain open for unimpeded flow. In the article, “Endometriosis Involving the Bowel,” obstruction of the intestines and the severe abdominal pain that can result is similar to obstruction of a ureter.
When endometriosis is present over, around, or in the ureter, think of stepping on a garden hose: everything backs up. The portion of the ureter above the partial or complete obstruction dilates, causing kidney-stone-like pain and even floods the kidney that causes its own function to deteriorate. Suddenly, homeostasis is in jeopardy.
What are the symptoms of endometriosis involving ureters or other parts of the urinary tract?
Endometriosis, like the lining of the uterus, cycles through periods of alternating stimulation and deterioration, all the while acting as a center for chronic inflammatory processes trapped in your abdomen/pelvis. Considering the nature of endometrial glandular tissue which you can witness on a tampon or sanitary napkin during the menstrual period, there is blood. Such blood can occur in the urine. When obstruction of a ureter begins to reach a certain degree, urine back-up can cause severe pain: the ureter, like the bowel, is covered with tissue extremely sensitive to distention and when distended, can cause disabling pain.
How is endometriosis involving the ureter diagnosed?
Endometriosis anywhere is diagnosed surgically—it must be witnessed, either by direct inspection or, as some experts insist, by biopsy which can reveal the glandular tissue via a microscope. Chances are, however, a woman will be suspected to have endometriosis due to other symptoms—pain or infertility—before any involvement over a ureter is considered. Thus, it is usually an incidental finding at the time of surgical diagnosis, although its significance isn’t incidental at all.
Today’s diagnostic approaches to endometriosis are so much better than yesterday’s, using minimally invasive, same-day surgery that appreciates the most sensitive of cosmetic concerns. Scarring is minimal or hidden, pain is significantly lower, and recovery is faster, which is important in one’s employment, activities of daily living, and day-to-day life. Additionally, the best part of these techniques—especially when the DaVinci robot is used, as is the routine for Advanced Endometriosis Center’ Dr. Bozdogan—is that the procedure takes advantage of the detailed virtual reality the robot makes possible—gingerly eliminating endometriosis with exquisite and precise surgical control, even when endometriosis is precariously implanted over bowel or a ureter. In this way, the initial diagnostic procedure can also be the therapeutic procedure to cure the disease (one less surgery!).
What special precautions are used to ensure the ureter is not damaged?
The goals of minimally-invasive robotic surgery over a ureter compromised by endometriosis are
- Elimination of the endometriosis, including at all other sites, to prevent recurrence of disease.
The robot makes possible views of the pelvis and abdomen conventional laparoscopy cannot; therefore, it is the best strategy to assure that all sites of endometriosis are caught and eliminated.
- Restoration of the function of the ureter to pass urine, unimpeded, toward the bladder.
- Produce the best cosmetic result with a minimum of pain, scarring, or recurrence of endometriosis.
Advanced Endometriosis Center
Here at Advanced Endometriosis Center, it is not lost on us what is at stake—fertility, proper function of your urinary tract anatomy, cosmetic sensibilities, and your quality of life, from athletics to sex to fertility. This is why we strive for the best approach, and the robotic technique is one’s best way to achieve these goals. After all, shouldn’t any surgery involve the best efforts, technologies, and outcomes? We think so.