1959 Laparoscopic Resection of Bladder and Uterine Cervix Endometriotic Nodule

Abstract

Video Objective Laparoscopic resection of bladder endometriosis is associated to the benefits of a minimally invasive approach. In this video, we aim to describe the surgical strategy applied in the treatment of anterior compartment deep endometriosis with bladder and uterine cervix infiltration. Setting Academic and public hospital. Patients A 37-year-old patient, with dysmenorrhea since the menarche, dysuria and dyspareunia for the last 3 years, without improvement with medical treatment. Complementary exams showed a 2,18cm bladder endometriosis nodule with an extension to cervical and anterior isthmic region of 1,87cm, and a proximity to the ureters bilaterally. The patient desired possible future fertility. Interventions Laparoscopic approach for treatment of bladder and uterine lesion. Measurements and Main Results Laparoscopic surgery identified the limits of the lesion. Nodule affected the round ligament bilaterally, bladder, and uterine serous layer. Both ureters were dissected since iliac bifurcation until uterine vessels. Horizontal incision was performed on the bladder around the lesion until the foley catheter visualization to avoid de ureteral meatus. Vesicouterine space was dissected and an 5cm lesion compromising the uterine serous to the cervix was removed. Yabuki space was recognized during the nodulectomy. Vaginal closure was made primordially followed by the vesical suture using 0 and 2-0 polygactin respectively. Operation was successfully completed. Patient was discharged 5 days later. Foley catheter and prophylactic antibiotic were used for 10 days. Social, urinary and sexual activities with improvement in pain and better quality of life. Conclusion Urinary tract endometriosis is a rare disease, but when it occurs the bladder is the most affected site. Patients often complain of dysuria, hematuria, and chronic pelvic pain. Partial bladder cystectomy offers complete removal of endometriotic nodule promoting improvement of urinary symptoms and quality of life.