Endometriosis is a condition in which tissue resembling that which normally lines the uterus grows outside the uterus, mainly in the pelvic area, behind the uterus, in the ovaries, and in the fallopian tubes. But endometriosis can also occur elsewhere, including in the urinary tract.

Urinary tract endometriosis is detected in about 1% to 4% of all cases. Here, it can be found in the ureter (the tube that carries urine from the kidney to the bladder) or in the bladder itself.

Symptoms of urinary tract endometriosis

Many women with endometriosis of the urinary tract may show no symptoms for a long time. The intensity and frequency of symptoms can also vary from patient to patient.

Symptoms of urinary tract endometriosis, when evident, are reported to include:

  • Urinary urgency and frequency
  • Blood in the urine
  • Pain during urination
  • Pain in the lower side of the back (flank pain)
  • Rare cases of infertility

If untreated, the ureter may become blocked over time, leading to loss of kidney function.

Diagnosis of urinary tract endometriosis

The diagnosis of urinary tract endometriosis requires a detailed review of the patient’s medical history and a physical examination by the doctor. A care team of urologists, gynecologists, and colorectal surgeons may be required to properly diagnose and treat this rare and likely underreported condition.

Imaging studies are often used to diagnose urinary tract endometriosis. Computerized tomography (CT) and magnetic resonance imaging (MRI) can provide a clear picture of any obstruction in the ureter.

Cystoscopy or laparoscopy are also commonly used to diagnose urinary tract endometriosis. These techniques involve inserting small cameras, using local or general anesthesia, to visualize the interior of the bladder and ureter.

Pelvic ultrasound can also be helpful in diagnosing urinary tract endometriosis. It may detect the presence of nodules on the ureter or bladder.

Treatment of urinary tract endometriosis

A combination of pain relief medications and hormone treatments may help to control the symptoms of urinary tract endometriosis, depending on their severity. However, because this type of endometriosis is deep-infiltrating, it is usually difficult to manage with medication, and surgical intervention may be required.

It the ureter is blocked or constricted by endometrial tissues, a stent (narrow tube) may be placed in the ureter to ease urine flow and reduce the burden on the kidneys. This stent is typically left in place for six weeks to help with urine flow and to protect the ureter during healing.


Last updated: August 5, 2019


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