Bladder Endometriosis Research Articles

Treatment of Patients With Bladder Endometriosis

Treatment of Patients With Bladder Endometriosis

Identification and Resection of Bladder Endometriosis

Identification and Resection of Bladder Endometriosis

A Rare Case of the Bladder Endometriosis and Overview of the Literature

Endometriosis is a chronic, non-cancerous condition characterized by the growth of endometrial tissue outside the uterus. Isolated involvement of the bladder is rare and often part of a broader deep infiltrating pelvic endometriosis. Bladder endometriosis should be considered in cases of unexplained dysuria and urinary symptoms not clarified by imaging or pelvic examination. Magnetic resonance imaging can be used as a diagnostic aid. This case report presents two patients diagnosed with bladder endometriosis postoperatively. Conservative treatment with gestagen preparations was administered. After 3-6 months of follow-up, ultrasonography and symptom assessment showed no recurrence. Clinicians should be aware of bladder endometriosis as a potential cause of persistent urinary symptoms, given its rarity and often delayed diagnosis.

Diagnosis of infiltrating bladder endometriosis after fourth cesarean section

ObjectivesThis case report highlights the clinical presentation, diagnostic challenges, and effective management of bladder endometriosis, while emphasizing the importance of considering this diagnosis in patients with chronic pelvic pain and urinary symptoms.MethodsA 32‐year‐old woman presented with severe pelvic pain, dysuria, and dyspareunia. Diagnosis of bladder endometriosis was achieved through clinical suspicion supported by vaginal ultrasound, 3D imaging, and magnetic resonance imaging.ResultsConservative medical treatment provided temporary relief, which necessitated resection of endometriotic nodule.ConclusionsDue to its rarity and non‐specific presentation, bladder endometriosis is often underdiagnosed or misdiagnosed. In this case, the patient's pain can be correlated with the deeply infiltrating nature of the endometriotic lesions, causing irritation, and involvement of the bladder.

Bladder Endometriosis: Symptoms and Pregnancy Outcomes

ObjectiveTo investigate the clinical features of bladder endometriosis and factors associated with urinary symptoms, pregnancy outcomes, and long-term effects of symptom relief and recurrence. DesignA single-center retrospective cohort study. SettingA tertiary referral hospital. ParticipantsForty-seven patients who were surgically confirmed to have bladder endometriosis at Peking Union Medical College Hospital between January 2012 and December 2023 were included in this study. InterventionsA retrospective study of the clinical and pathological features and reproductive outcomes in patients with bladder endometriosis. Measurements and Main ResultsAmong 47 patients with bladder endometriosis, 27 (57.4%) presented with urinary symptoms, including urinary frequency, urgency, dysuria, and hematuria. Patients with urinary symptoms were more likely to have previous cesarean sections (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.1–19.2, p = .032) and experience dysmenorrhea compared to those without (p = .008, OR 5.3, 95% CI 1.5–18.8). Anterior compartment obliteration was another factor associated with urinary symptoms (OR 7.2, 95% CI 1.3–40.4, p = .016). Bladder lesions located within 1 cm of the ureteral orifice (OR 7.2, 95% CI 1.3–40.4, p = .020) and the deeper invasive layer of lesions (mucosal layer, OR 6.1, 95% CI 1.4–25.8, p = .009) were also found to be associated with symptoms. Regarding reproductive outcomes, 12 patients desired to conceive. Of the patients who desired pregnancy, 66.7% achieved pregnancy; 5 spontaneously and 3 after IVF treatment. The miscarriage rate among patients with bladder endometriosis was 25.0% in the age range of 27–40 years. Additionally, all patients experienced symptom relief after one year of follow-up. Only two patients experienced bladder endometriosis recurrence. ConclusionsPrevious cesarean section, dysmenorrhea, anterior compartment obliteration, lesion in the trigone, and mucosal layer invasion were identified as factors associated with urinary symptoms. Although some patients conceived successfully after surgery, disentangling the independent effect of bladder endometriosis on fertility remains challenging.

Endometriosis of the appendix: prevalence, associated lesions, and proposal of pathogenetic hypotheses. A retrospective cohort study with prospectively collected data.

To assess the prevalence of endometriosis of the appendix and the association with other pelvic localizations of the disease and to provide pathogenesis hypotheses. Monocentric, observational, retrospective, cohort study. Patients undergoing laparoscopic endometriosis surgery in our tertiary referral center were consecutively enrolled. The prevalence of the different localizations of pelvic endometriosis including appendix involvement detected during surgery was collected. Included patients were divided into two groups based on the presence of appendiceal endometriosis. Women with a history of appendectomy were excluded. Four hundred-sixty patients were included for data analysis. The prevalence of appendiceal endometriosis was 2.8%. In patients affected by endometriosis of the appendix, concomitant ovarian and/or bladder endometriosis were more frequently encountered, with prevalence of 53.9% (vs 21.0% in non-appendiceal endometriosis group, p = 0.005) and 38.4% (vs 11.4%, p = 0.003), respectively. Isolated ovarian endometriosis was significantly associated to appendiceal disease compared to isolated uterosacral ligament (USL) endometriosis or USL and ovarian endometriosis combined (46.2% vs 15.4% vs 7.7%, p < 0.001). Poisson regression analysis revealed a 4.1-fold and 4.4-fold higher risk of ovarian and bladder endometriosis, respectively, and a 0.1-fold risk of concomitant USL endometriosis in patients with appendiceal involvement. Involvement of the appendix is not uncommon among patients undergoing endometriosis surgery. Significant association was detected between appendiceal, ovarian, and bladder endometriosis that may be explained by disease dissemination coming from endometrioma fluid shedding. Given the prevalence of appendiceal involvement, counseling regarding the potential need for appendectomy during endometriosis surgery should be considered.

Robot-Assisted Partial Cystectomy for Deep Infiltrating Endometriosis of the Bladder With the Hugo RAS System

ObjectiveInvolvement of the lower urinary tract is found in 0.2 to 2.5% of all deep infiltrating endometriosis (DIE) [1,2]. The bladder is the most affected organ with a prevalence of up to 80% of cases [3]. Patients with bladder endometriosis are often symptomatic (dysuria, hyperactive bladder, recurrent urinary tract infections, and hematuria). Surgery is the gold standard treatment for this condition when medical therapy fails [1,2]. Several studies have shown the feasibility, effectiveness, and safety of the laparoscopic approach [4] but data about robotic-assisted approach are missing in literature. Currently, novel platforms are entering the market and the Hugo™RAS (Medtronic, Minneapolis, USA) is a new system (HRS) consisting of an open console with 3D-HD screen and a multimodular bedside units. Even if some series are already available for radical cystectomies for oncologic purposes [5], a full description of DIE surgery performed with HRS is still lacking. Aim of this video-article is to show our technique and surgical setup to carry out a complex case of anterior compartment DIE. DesignA step-by-step explanation of surgical technique with narrated video footage. SettingTertiary Level Academic Hospital “IRCCS Azienda Ospedaliero—Universitaria di Bologna” Bologna, Italy. InterventionA 36-year-old nulliparous woman affected by DE was referred to our center due to severe dyspareunia, dysuria with hematuria and postvoiding pain not responsive to oral progestins. The preoperative work up consisted of a gynecological examination, pelvic ultrasound and MRI that showed the presence of an endometriotic nodule of the bladder base. All possible therapeutic strategies and related complications have been discussed with the patient before the signature of the informed consent. To carry out the procedure a “straight” port placement in a “compact” docking configuration [6] was installed. After developing the paravesical spaces bilaterally, the bladder nodule was approached in a latero-medial direction then a partial cystectomy with macroscopical free margins was performed. A double layer horizontal running suture with barbed thread was used to repair the bladder wall. ConclusionTo the best of our knowledge, this is the first case of bladder endometriotic nodule excision performed with HRS. We explained our technique and robotic set-up to successfully manage a compelx case of DIE of the bladder. Video Abstract [Display omitted]

A Unique Occurrence of Vesical Endometriosis 16 Years After Cesarean Section: A Case Report

&lt;strong&gt;Background:&lt;/strong&gt; The rare disorder urinary bladder endometriosis develops when endometrial tissue, which lines the uterus, grows in the bladder wall. This aberrant endometrial tissue causes hematuria, dysuria, and pelvic discomfort. Though, these symptoms are not exclusive to this illness, they make diagnosis difficult. Ultrasound, Magnetic Resonance Imaging, and cystoscopy play a crucial role in confirming the diagnosis. Treatment options range from medical management with hormonal therapies to surgical interventions like transurethral resection or partial cystectomy depending upon personal needs and endometriosis severity. &lt;strong&gt;Case Presentation:&lt;/strong&gt; We are presenting a case report highlighting this uncommon yet clinically significant presentation of urinary bladder endometriosis in a 38-year-old female, who had been experiencing cyclical dysuria for about one year. Her medical history included two previous Caesarean deliveries with last being 16 years ago. MRI revealed variable intensity lesion with internal cystic areas along left posterolateral urinary bladder wall which was inseparable from lower segment caesarean section scar, indicative of urinary bladder endometriosis. Patient received medical treatment leading to resolution of her symptoms. &lt;strong&gt;Conclusion:&lt;/strong&gt; Urinary bladder endometriosis following caesarean section is an uncommon but clinically significant condition that demands timely recognition and appropriate management. A thorough diagnostic workup, including imaging studies and cystoscopy, is crucial for accurate diagnosis. Tailored treatment plans, ranging from hormonal therapies to surgical interventions, should be considered based on disease extent, fertility desires, and overall patient health.

Bladder endometriosis – diagnostic and management challenges: A case report

Background: Urinary tract endometriosis (UTE) is the presence of endometriotic implants in the bladder,ureter, kidneys, or urethra. It affects ~1% of women with endometriosis and occurs more commonlyamong those with deep infiltrative endometriosis. Bladder endometriosis is the most commonpresentation, comprising 85% of cases. Concomitant involvement of the bladder and ureter is rare,comprising 1.4% of all cases. The clinical presentation involves lower urinary tract symptoms, thatworsen during menses. Timely diagnosis and treatment are crucial in ameliorating symptoms andpreventing complications, such as obstructive nephropathy. This is a case of bladder endometriosis withureteral involvement, outlining management challenges, reviewing evidence on managementapproaches, and highlighting the experience gained from this case in managing complex UTE.Case presentation: A 38-year-old female presented with a longstanding history of pelvic pain, dysuria,and new-onset voiding difficulty. She had undergone two prior surgical procedures for endometriosis,including a total abdominal hysterectomy. Her physical examination was normal. Ultrasound revealed a3-cm intracavitary bladder mass, which was described as likely endometriosis on magnetic resonanceimaging. On cystoscopy the mass was noted to be larger, encasing the left ureteric meatus. Alaparoscopic cystostomy was performed, with partial resection of the mass and placement of a temporaryureteric stent. After three months of medical treatment with dienogest, cystoscopy revealed a significantreduction in size with sub-centimeter residual avascular tissue. This was resected avoiding the ureter andureteric meatus. A new ureteric stent was placed. A repeat cystoscopy three months later revealed goodhealing with no residual endometriosis. The stent was removed, and a retrograde pyelogram confirmedno meatal stenosis or ureteric obstruction. She has remained symptom-free.Conclusion: Medical and surgical options are available for bladder endometriosis, with partialcystectomy being the gold standard. The initial approach is dependent on the size of the lesion and theextent of ureteric involvement. A staged approach that combines medical or surgical management canensure optimal outcomes while reducing surgery-associated morbidity in complex cases.

Bladder endometriosis-A great masquerader

The bladder is the most common site affected in urinary tract endometriosis. There is a controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and the risk of malignant transformation of bladder endometriosis. Patients presenting with symptoms typically attributed to endometriosis might go unnoticed because of its infrequent occurrence. We, hereby, report a case of a young female who had complaints of burning micturition and dysmenorrhea. After a thorough evaluation, she was found to have a urinary bladder mass which was subjected to a biopsy. The initial histopathology report came as bladder malignancy but immunohistochemistry proved otherwise and it turned out to be urinary bladder endometriosis.

When cystoscopy catches what laparoscopy misses: The role of cystoscopy in evaluation of bladder endometriosis

When cystoscopy catches what laparoscopy misses: The role of cystoscopy in evaluation of bladder endometriosis

Outcomes of Urinary Tract Endometriosis-Laparoscopic Treatment: A 10-Year Retrospective Study.

Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE. We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012-2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.

Clinical Features of and Minimally Invasive Surgery for Bladder Endometriosis: A Series of 24 Cases

Clinical Features of and Minimally Invasive Surgery for Bladder Endometriosis: A Series of 24 Cases

Complex Bladder Endometriosis with Ureteral Obstruction: Tenets of Surgical Management

Complex Bladder Endometriosis with Ureteral Obstruction: Tenets of Surgical Management

Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review.

This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies. Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo's database using the following MeSH terms: ('endometriosis') AND ('urology' OR 'urological' OR 'urologist') AND ('bladder' OR'vesical') AND ('ureteral' OR 'ureter').Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings. Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification. DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques.

Robotic Surgery for Bladder Endometriosis: A Systematic Review and Approach.

Women with bladder endometriosis often present with more advanced stages of endometriosis. Robotic surgery has emerged as a promising approach to the management of bladder endometriosis. This systematic review aims to analyze the current literature on robotic surgery for bladder endometriosis and describe our systematic approach to surgical treatment. This review followed the PRISMA guidelines, which ensured a comprehensive and transparent approach to selecting and evaluating relevant studies. We conducted a thorough literature search to identify studies that investigated the use of robotic surgery for bladder endometriosis. Relevant databases were searched, and inclusion and exclusion criteria were applied to select eligible studies. Data extraction and analysis were performed to assess the outcomes and effectiveness of robotic surgery for the treatment of bladder endometriosis. We did not find any randomized clinical trials with the use of robotics in the treatment of bladder endometriosis. We found only two retrospective studies comparing robotic surgery with laparoscopy, and another retrospective study comparing robotic surgery, laparoscopy, and laparotomy in the treatment of bladder endometriosis. All the other 12 studies were solely case reports. Despite the lack of robust evidence in the literature, the studies demonstrated that robotic surgery is feasible and is associated with reduced postoperative pain, shorter hospital stays, and faster recovery. The utilization of robotic technology is a promising option for the surgical management of bladder endometriosis. We advocate a surgical systematic approach for the robotic treatment of bladder endometriosis. Robotic technology, with its 3D vision, instrumental degrees of freedom, and precision, particularly in suturing, may provide potential benefits over traditional laparoscopy.

Bladder Endometriosis in Perimenopausal Woman- A Rare Case Report

Endometriosis is a gynaecological disease. It is caused by the presence of the endometrial tissue exterior of the uterus. A 45-year-old woman presented with recurrent episodes of dysuria. Computed tomography (CT) scan showed ill-defined mildly enhancing soft tissue density within the vesicouterine region showing loss of fat planes with the posterior wall of the urinary bladder in the region of the trigone s/o bladder endometriosis. The patient was planned for cystoscopy and cystoscopy resection of bladder endometriosis. Endometrioma was resected using a resectoscope. Bilateral ureteric reflexes were elicited, and the rest of the bladder mucosa was normal. Effective treatment of bladder and urethral endometriosis is best done in collaboration with a team of doctors familiar with endometriosis, such as a gynaecological, radiologist, and urologist.

Bladder endometriosis. Clinical case and literature review

Bladder endometriosis. Clinical case and literature review

Easy Steps for Excision of a Deep Infiltrative Endometriotic Bladder Nodule

Background: Eighty-five percent of the time that endometriosis is found in the urinary tract, the condition is found on the bladder itself. Common symptoms include dysuria, hematuria, urinary urgency, and bladder pain. These symptoms may worsen with menstruation. This article presents a patient with signs and symptoms of bladder endometriosis. Imaging revealed a bladder nodule and other lesions suspicious for endometriosis. The patient opted for surgical management. The surgical solution was to excise the bladder nodule by creating a cystotomy and repairing the bladder using a two-layer closure technique. Given that the patient presented with a compilation of several bladder symptoms and imaging showed a bladder nodule, she was an optimal candidate for surgical intervention. Technique: The technique described in this article is an efficient and effective method of excising a deep infiltrative endometriotic (DIE) bladder nodule. A video (Supplementary Video. SV1; Supplementary Data are available online at www.liebertonline.com/GYN) demonstrates the steps of a DIE bladder-nodule excision. This is a simple and reproducible technique for all gynecologic surgeons who manage endometriosis. Conclusions: A total excision of a DIE bladder nodule is an effective treatment modality for patients with pelvic pain and suspected bladder endometriosis. Supplementary Video SV1 highlights reproducible steps that can be performed easily by gynecologic surgeons when encountering a DIE bladder nodule. (J GYNECOL SURG 20XX:000)

Bladder Endometriosis: Case Report and Literature Review

Bladder endometriosis is a rare location of endometriosis. We present a case of female patient with an inter vesical-uterine septum mass that was an incidental finding during the realization of a pelvis IMR to characterize an ovarian tumor. We performed a surgical resection. Histopathological examination revealed a bladder adenomyomas.