Abstract：
OBJECTIVE: To evaluate ureteral involvement using transvaginal sonography (TVS) regarding the distortion of the course of the ureters caused by deep endometriosis (DE), which can facilitate predicting the need for ureterolysis during surgery, even in the absence of ureteral stenosis or dilatation.
METHODS: This is a single-center, observational, retrospective pilot study of 88 consecutive patients who later underwent surgery for DE that used ultrasound preoperative diagnosis of ureteral medial deviation of one or both ureters between January 2019 and January 2022. At TVS, the course of the ureter was considered medialized if, in longitudinal and transversal section, any distance was detectable between the ureter and the cervix at the point where the ureter crosses the uterine artery. The primary end point was to determine sensitivity, specificity, and positive and negative predictive values of \"ureteral medial deviation\" diagnosed using TVS, in order to predict the need for ureterolysis.
RESULTS: Our series included 88 women with a median age of 39 (interquartile range 33-43) years. Ureteral medialization showed a relatively low false-positive rate (10.9%), with a specificity of 89.1% (95% confidence interval [CI] 81.4%-96.7%) and a sensitivity of 86.6% (95% CI 80.3%-92.9%), along with a high positive predictive value of 93.3% (95% CI 88.4%-98.1%), and a lower negative predictive value of 79.1% (95% CI 69.8%-88.5%), respectively.
CONCLUSIONS: This study introduced a new ultrasound sign with a high degree of accuracy to predict ureterolysis and this may have positive implications in the management and surgical planning of patients with ureteral endometriosis.
METHODS: This is a single-center, observational, retrospective pilot study of 88 consecutive patients who later underwent surgery for DE that used ultrasound preoperative diagnosis of ureteral medial deviation of one or both ureters between January 2019 and January 2022. At TVS, the course of the ureter was considered medialized if, in longitudinal and transversal section, any distance was detectable between the ureter and the cervix at the point where the ureter crosses the uterine artery. The primary end point was to determine sensitivity, specificity, and positive and negative predictive values of \"ureteral medial deviation\" diagnosed using TVS, in order to predict the need for ureterolysis.
RESULTS: Our series included 88 women with a median age of 39 (interquartile range 33-43) years. Ureteral medialization showed a relatively low false-positive rate (10.9%), with a specificity of 89.1% (95% confidence interval [CI] 81.4%-96.7%) and a sensitivity of 86.6% (95% CI 80.3%-92.9%), along with a high positive predictive value of 93.3% (95% CI 88.4%-98.1%), and a lower negative predictive value of 79.1% (95% CI 69.8%-88.5%), respectively.
CONCLUSIONS: This study introduced a new ultrasound sign with a high degree of accuracy to predict ureterolysis and this may have positive implications in the management and surgical planning of patients with ureteral endometriosis.
摘要：
目的：使用经阴道超声检查（TVS）评估深部子宫内膜异位症（DE）引起的输尿管走行变形，这有助于预测手术期间输尿管溶解的需要，即使没有输尿管狭窄或扩张。
方法：这是一个单中心，观察,在2019年1月至2022年1月期间接受DE手术的88例连续患者的回顾性试点研究,这些患者使用超声术前诊断一个或两个输尿管内侧偏离.在TVS,输尿管的过程被认为是中介的，如果，在纵向和横向截面中，在输尿管穿过子宫动脉的位置处，输尿管和子宫颈之间可以检测到任何距离。主要终点是确定灵敏度，特异性，以及使用TVS诊断的“输尿管内侧偏离”的阳性和阴性预测值，以预测输尿管溶解的需要。
结果：我们的系列包括88名女性，中位年龄为39岁（四分位距33-43岁）。输尿管内中显示相对较低的假阳性率（10.9％），特异性为89.1%（95%置信区间[CI]81.4%-96.7%），灵敏度为86.6%（95%CI80.3%-92.9%），伴随着93.3%的高阳性预测值(95%CI88.4%-98.1%)，阴性预测值较低，为79.1%(95%CI69.8%-88.5%)，分别。
结论：这项研究引入了一种新的超声征象，具有很高的预测输尿管溶解的准确性，这可能对输尿管子宫内膜异位症患者的治疗和手术计划具有积极的意义。
方法：这是一个单中心，观察,在2019年1月至2022年1月期间接受DE手术的88例连续患者的回顾性试点研究,这些患者使用超声术前诊断一个或两个输尿管内侧偏离.在TVS,输尿管的过程被认为是中介的，如果，在纵向和横向截面中，在输尿管穿过子宫动脉的位置处，输尿管和子宫颈之间可以检测到任何距离。主要终点是确定灵敏度，特异性，以及使用TVS诊断的“输尿管内侧偏离”的阳性和阴性预测值，以预测输尿管溶解的需要。
结果：我们的系列包括88名女性，中位年龄为39岁（四分位距33-43岁）。输尿管内中显示相对较低的假阳性率（10.9％），特异性为89.1%（95%置信区间[CI]81.4%-96.7%），灵敏度为86.6%（95%CI80.3%-92.9%），伴随着93.3%的高阳性预测值(95%CI88.4%-98.1%)，阴性预测值较低，为79.1%(95%CI69.8%-88.5%)，分别。
结论：这项研究引入了一种新的超声征象，具有很高的预测输尿管溶解的准确性，这可能对输尿管子宫内膜异位症患者的治疗和手术计划具有积极的意义。
