Easy Steps for Excision of a Deep Infiltrative Endometrial Bladder Nodule

Abstract

<h3>Study Objective</h3> To demonstrate an efficient and effective method of excising a deep infiltrative endometriotic (DIE) bladder nodule. <h3>Design</h3> A stepwise demonstration of the resection of an endometriotic bladder nodule with narrated video footage. <h3>Setting</h3> This video will demonstrate the steps of a deep infiltrative endometriotic bladder nodule excision, a simple and reproducible technique for all gynecologic surgeons who manage endometriosis. <h3>Patients or Participants</h3> A 30-year-old female with a history significant for endometriosis who previously underwent a right salpingo-oophorectomy presenting with dysmenorrhea, hematochezia, and bladder pain with menstruation. Ultrasound revealed a left ovarian endometrioma, as well as a bowel and bladder nodule, suspicious for endometriosis. After discussing possible treatment options with the patient, she opted for fertility preserving surgical management as well as excision of all endometriotic lesions. <h3>Interventions</h3> Easy steps that can be reproduced for the excision of a bladder nodule include: Identification of the ureters and mobilization of the bladder, identification of the endometriotic bladder nodule, excision of the nodule with full thickness if necessary, accessing the ureteral orifices in relation of the lesion, closing the cystotomy, and confirming a water tight closure. <h3>Measurements and Main Results</h3> Pathology confirmed endometriosis of both bowel and bladder nodules. The patient recovered well without any postoperative complications. <h3>Conclusion</h3> A total excision of a DIE bladder nodule is an effective treatment modality for patients with pelvic pain and suspected endometriosis. This video highlights reproducible steps that can be easily performed by gynecologic surgeons when encountering a DIE bladder nodule.