During the procedure, the surgeons had to shift the bladder out of its normal position into the abdomen so that it could connect with the damaged ureter, which had been cut short by the scarring. They then reimplanted the ureter into the bladder. To hold the bladder in place, they had to stitch it to a tendon on the psoas muscle, which runs alongside the spine and into the pelvis. The process is a tedious one and was complicated in this case by the need to remove a large amount of endometrial scar tissue in the abdominal and pelvic cavity, Nezhat said. The procedure took about three hours.
Endometriosis typically affects the reproductive organs and can lead to infertility.
In about 10 percent of patients, the endometrial scarring also extends into the lower urinary tract, Freiha said. Fewer than 1 percent of patients, however, have enough involvement in this region to require a psoas hitch, he said. For patients, the benefits of a laparoscopic approach to the procedure are enormous, Freiha said. Patients experience less pain, have less surgical scarring and may spend just two or three days in the hospital, rather than a week or more, he said. The patient, who has had three previous surgeries for endometriosis, said she hopes the procedure will now make it possible for her to become pregnant.