The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice

Authors


Sir,

I read with interest the retrospective 10-year series about the use of JJ stent while dealing with ureteral endometriosis.1 I congratulate the authors on their work to deal with such a problem without resorting to laparotomy. However, there are a number of issues that need to be highlighted.

It would have been helpful to make it clear that the paper looks at using JJ stents for prevention and early detection of ureteric injury in a cohort of 17 women with extrinsic endometriosis affecting the ureters from a total of 145 women having laparoscopic surgery for endometriosis in two tertiary units over 10-year period. This small number over 10 years in two tertiary referral units shows how rare ureteric endometriosis is, and this should be stressed. It would have been useful to outline the basis of labelling the cases as deep endometriosis, such as American Fertility Society Scores. Giving an idea about the extent of such lesions and their relation to the ureter as well as any previous surgery, at the centre or prior to referral to it, especially in those women who required ureteric resection, would help the reader appreciate which cases might benefit from the technique.

It would have been useful to understand the value of using JJ, rather than straight, ureteric stents, especially with the long duration these stents were kept. The article describes laparoscopic management of ureteric injuries, but it is not clear where these injuries were, how they happened and whether they were sutured or not. The fact that 5 women, from a total of 17 women, had major ureteric complications despite having a JJ stent inserted is worth discussing further. Likewise, the fact that JJ stent obstruction was encountered deserves clarification. It is difficult to conclude a right–left asymmetry of ureteric endometriosis without significance testing, especially with the small number of cases included.

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