Silent but Destructive: Ureteral Deep Infiltrating Endometriosis Progressing to Renal Injury – A Case Report

Background: Ureteral endometriosis is a rare form of deep infiltrating endometriosis that may lead to silent ureteral obstruction and progressive renal injury. Early diagnosis remains challenging because symptoms are often nonspecific. Case Report: A 41-year-old nulliparous woman presented with lower abdominal pain radiating to the rectum and thigh. Pelvic examination revealed an immobile posterior cervical mass. Transvaginal ultrasound demonstrated a deep infiltrating endometriosis nodule associated with hydroureter and grade IV hydronephrosis, which was confirmed by magnetic resonance imaging. Surgical management was recommended; however, the patient declined surgery and opted for conservative treatment. She received monthly leuprolide acetate injections for three months. Follow-up evaluation showed reduction in lesion size and improvement in pain symptoms. Conclusion: Ureteral endometriosis should be considered in reproductive-age women with unexplained hydroureteronephrosis. Hormonal therapy may provide temporary symptom control in patients refusing surgery, although careful follow-up is required because of the risk of ongoing renal damage.