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Author’s Reply

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Sir,

We thank Dr Ismail for his interest in our article and offer the following comments.1,2

We feel that the objectives of the article are very explicit and were clearly outlined in the introduction of the article. We disagree with the comment made about using JJ stents for ‘the early detection of ureteric injury’; our intention was never to use JJ stents for the detection of ureteric injury but for the prevention of and treatment of injury to the ureter.

While we agree that ureteric endometriosis is rare, we state this clearly in our paper. The study was retrospective, looking at the years 2004–07, not a 10-year period as Mr Ismail suggests. Moreover, there were three and not five ureteric complications, and we feel these were adequately explained in the paper. We would have welcomed the opportunity to clarify further the case of the woman with JJ stent obstruction, but this woman is actually a patient from another tertiary centre, who after several previous operations was referred to our department for a final attempt of complete endometriosis resection. Her case being so unusual and complex, a detailed description of her case would warrant a case report.

Regarding the classification of the cases, they were all grade IV according to the revised American Fertility Society Scores, but this gives us no useful information; indeed, the presence of ureteral endometriosis is classified as ‘additional endometriosis’ and does not give any anatomical details nor guide towards a specific surgical technique.

We appreciate the remark of Ismail requesting further detailed description of the type, location, timing of ureteric injuries and the patients’ previous surgeries, but this would be beyond the confines of the article. In simple terms, when operating on the ureter, if we encountered any mucosal breach, we would suture it.

Finally, it is our practice to use JJ stents rather than straight stents as we find them easy to use and have long-term practice with them. We could not comment on the use of straight stents.

References

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  2. Author’s Reply
  3. References
  • 1
    Ismail S. The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice. BJOG 2008;115:1715.
  • 2
    Weingertner A, Rodriguez B, Ziane A, Gibon E, Thoma V, Osario F, et al. The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice. BJOG 2008;115:115964.