A 54-year-old Italian Caucasian woman, weighing 71 kg and with a height of 160 cm, was admitted to our facility in order to have a laparoscopic removal of two nodules compressing both ureters. She had received diagnosis of endometriosis laparoscopically, when she was 43. At 44 years of age, she underwent a total laparotomic hysterectomy with bilateral adnexectomy for metrorrhagia from uterine fibromatosis. During the operation and after pathological examination, no sign of endometriosis was found. Subsequently, she underwent voluntary hormone replacement therapy (estrogen-based only) for seven years with good general health until the detection, during the eighth year of menopause, of renal failure due to bilateral hydronephrosis (detected via MRI). The bilateral hydronephrosis was induced by extrinsic compression of both ureters (at supravesical fossa) by nodules compatible with deeply infiltrating endometriosis. S-Ca 125 appeared within the norm (normal values are considered below 31 microU/ml) and no pelvic pain was reported. Upon hospitalization, five months after instrumental diagnosis and following subsequent ureteral stenting, her creatinine value was 1.71 mg/dl (range 0.66 to 1.09 mg/dl), with blood urea nitrogen at 57 mg/dl (range 17 to 43 mg/dl). S-Ca 125 again appeared to be within the normal range (below 31 microU/ml). She then underwent operative laparoscopy with adhesiolysis of entero-enteric adhesions and excision of endometriotic nodules encompassing the juxtavesical tract of the ureters: on the right extending to the external iliac artery and obturator foramen and on the left, to the rectum. Pathological examination of the excised nodules confirmed the instrumental and laparoscopic diagnosis of postmenopausal endometriosis. Post-operative recovery was complicated by broncho-pneumonia. After hospital discharge, creatinine value was 1.56 mg/dl (range 0.66 to 1.09 mg/dl) with thinning of the right renal cortex which suggested mild renal failure. Following removal of the ureteral stents three months after surgery, the patient appeared to be in good health despite the mild renal failure.