Bladder Endometriosis Research Articles

Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections

Urological endometriosis is rare and accounts for approximately 1% of women with endometriosis. The pathophysiology of bladder endometriosis may be divided into two different causes, namely primary and secondary. The primary form occurs spontaneously and manifests in a form of a generalized pelvic disease whereas the secondary form is thought to be iatrogenic and typically occurs after pelvic surgery such as Cesarean section or hysterectomy. We present a case report on a patient presenting with an invasive bladder mass initially thought to be from a pelvic malignancy. The final histology showed isolated bladder endometriosis. She had a significant past medical history of two previous Cesarean sections. A review of her magnetic resonance imaging (MRI) images demonstrated the presence of a Cesarean scar niche which may be linked to her bladder endometriosis. There is a need to improve awareness of the possible link between Cesarean scar niche with bladder endometriosis. This is important as it raises the clinical question of whether appropriate repair of Cesarean scar niches can prevent future complications such as bladder endometriosis which can potentially be associated with significant morbidity. J Med Cases. 2020;11(11):370-373 doi: https://doi.org/10.14740/jmc3543

Efficacy of Laparoscopic Partial Cystectomy with a Transurethral Resectoscope in Patients with Bladder Endometriosis: See-Through Technique

Purpose: Bladder endometriosis (BE) is rare. Deep invasive endometriosis is difficult to control with medications alone; such cases need surgical treatment. Good results of laparoscopic partial cystectomy with a transurethral (TU) resectoscope by the see-through technique for patients with BE are reported. Materials and Methods: From January 2008 to February 2016, 12 cases of symptomatic BE were seen in our institution. The chief complaints of 9 cases were micturition pain during menstruation. Preoperative cystoscopy showed a bladder mass with blueberry spots. All surgeries were performed under general anesthesia. Laparoscopic surgery was performed with a fan of 4 ports in the lower abdomen. First, the uterus and bilateral ovaries were checked. Then, the TU resectoscope was inserted. When the affected bladder wall was identified, it was again observed with the laparoscopic light source off, which made it possible to observe the twilight leaking inside from the bladder. This twilight came from the light source of the TU resectoscope via the unaffected bladder wall. In contrast, the thickness of the affected wall prevented the light from inside the bladder from passing through it. We call this the “see-through technique.” The tumor was then safely dissected with both laparoscopic and TU resection procedures. Finally, the bladder was sutured by laparoscopic procedures using absorbable sterile surgical suture. The urethral catheter was removed after cystography 7 days after the operation. Results: The surgical margins of all cases were negative. There has been no recurrence of BE so far in any patients. There were no major adverse events perioperatively and the urinary symptoms improved in all cases. Conclusions: By laparoscopic partial cystectomy assisted with a TU resectoscope and see-through technique, the edge of BE could be easily and precisely identified. These procedures are effective and safe for BE surgical treatment.

Bladder endometriosis in pregnancy

Bladder endometriosis in pregnancy

Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study.

To investigate how many examinations it takes to be able to identify the pelvic parts of the ureters on transvaginal sonography (TVS). This was a prospective study including consecutive women attending a gynecological outpatient clinic in a tertiary referral setting. Prior to commencement of the study, three trainees, with a focus on gynecological surgery and TVS but with no experience in identifying ureters, each observed an expert examiner performing 10 routine TVS examinations, including identification of both ureters. All were standardized gynecological TVS examinations, with visualization of the pelvic part of both ureters. Consecutive women were then examined, first by the expert, unobserved by the trainees, and then by one of the three trainees, in the presence of the expert. To ensure that identification of the pelvic parts of the ureters could be incorporated feasibly into routine gynecological TVS in a tertiary referral setting, a time limit of 150 s was set for successful identification of each ureter. A successful examination was defined by identifying both ureters within the time limit. The number of women examined by each trainee was determined by how quickly they achieved proficiency, which was evaluated using the learning curve cumulative summation (LC-CUSUM) score. Between January 2017 and June 2017, a total of 140 women were recruited for the study, with 135 patients being included in the final analysis. The three trainees were able to identify the right ureter after a maximum of 48 (range, 34-48) TVS examinations, and the left ureter after a maximum of 47 (range, 27-47) TVS examinations. Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40-50 TVS examinations. Detection of the ureters is a feasible part of the TVS workup of patients attending a clinic in a tertiary referral center. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Intramural Bladder Endometriosis Secondary to Cesarean Section

Intramural Bladder Endometriosis Secondary to Cesarean Section

Transurethral Resection of a Bladder Tumor in Pregnancy: Decidual Reaction Bladder Endometriosis.

Background: Decidual reaction bladder endometriosis (DRBE) is exceedingly rare with few reported cases in the literature. It presents as a bladder mass during pregnancy, and may be accompanied by lower urinary tract symptoms. Histologic diagnosis is necessary to rule out primary bladder malignancy. We present a case of a bladder tumor identified during pregnancy. The mass was managed endoscopically and found to be DRBE, a rare benign entity. Case Presentation: We present a 31 year old 15 weeks pregnant nonsmoker woman with a rapidly enlarging bladder mass concerning for primary bladder malignancy. Mass confirmed on formal renal/bladder ultrasound and in-office cystoscopy. After informed consent was obtained, the patient was taken to the operating room. A 5.5 cm bladder mass, with an atypical nodular appearance and minor calcifications, was identified. Transurethral resection of the mass was performed. Final pathology report showed florid endometriosis with stromal decidualization. Final diagnosis: pregnancy induced vesical decidualized endometriosis simulating a bladder tumor. Patient continued routine obstetrics follow-up, and has experienced no pregnancy-related complications. Three months after delivery the patient will follow up with outside urology provider for cystoscopy, and subsequent surgical management should it be necessary. Conclusion: DRBE is a rare benign bladder mass that presents in pregnancy. It can grow rapidly raising concern for an aggressive primary bladder malignancy. Any bladder mass identified in pregnancy should undergo early, appropriate work-up given the potential risk for bladder cancer. After diagnosis, DRBE is most often managed conservatively. After delivery, should the patient experience ongoing urinary symptoms, medical and surgical treatment options are available. Overall, DRBE is considered rare, but should be considered in the differential diagnosis for any bladder mass presenting during pregnancy.

Laparoscopic partial cystectomy for bladder endometriosis – case report

Introduction. Endometriosis is defined as a presence of endometrial glands and stroma outside the uterus. Urinary track endometriosis is a rare occurrence (1-2%) usually associated with bladder involvement (85%). Aim. The diagnostic evaluation is not complicated but can be delay because of the lack of specific symptoms. Description of the case. We present a case of 20-years old female with bladder endometriosis localized on the posterior wall. The patient was effective treated with laparoscopic partial cystectomy Conclusion. The patient was effective treated with laparoscopic partial cystectomy.

2934 Minimally Invasive Treatment of Bladder Deep Endometriosis and Isthmocele

Video Objective To demonstrate the endoscopic management of bladder endometriosis and isthmocele. Setting Bladder endometriosis, defined by the presence of detrusor muscle layer invasion, affect around 1%-2% of womens. In nowadays, laparoscopic partial cystectomy is the gold standard surgical treatment. By other hand, the isthmocele is a defect of the anterior wall of the cervical canal at the site of the previous C-section, and affect around 0.6% of women's. It will be symptomatic in about 30% of the cases with AUB as the main presentation. Laparoscopic treatment report between 59%-90% of symptom control, and will be choose when overlying myometrial mantle is less than 3mm and/or 50% of total myometrial thickness. Due the invasive nature of endometriosis, added to the inflammatory response following the c-section heal, it is not surprising that both pathologies could be anatomically closer. A 37 years old patient, with clinical history of dysuria, cyclic hematuria and post-menstrual spotting. Ultrasound evidence a 29 millimeter hypo-echogenic nodule at the bladder dome plus a 12mm isthmocele, with overlying miometrial mantle of 7mm. Interventions Hysteroscopic isthmoplasty was done using a mini-resectoscope including the treatment of both caudal and cranial edges and resection of all the diverticular mucosal hyperplasia. Posteriorly, laparoscopic partial cystectomy was done. Under general anesthesia, the patient was placed in 0 degrees dorsal decubitus with her arms alongside her body. Operative set-up include 15mmhg pneumoperitoneum and four trocars: a 10mm trocar at the umbilicus for a zero-degree laparoscope; a 5mm trocar in the right and left iliac fossa; and a 12mm trocar in the suprapubic area. Using mechanical, electrical and ultrasonic energy, partial cystectomy followed by two layer closure was done. During final chromotubation, massive leakage was noted coming from the isthmic area. Complementary laparoscopic resection and closure was done. Histopathological result show no cleavage plane between isthmus area and bladder endometriosis tissue. Conclusion Full endoscopic treatment of bladder endometriosis and Isthmocele is feasible, safe and effective in experienced hands. In this patient, procedure was uneventful, without any intra or pos-operative complications.

1959 Laparoscopic Resection of Bladder and Uterine Cervix Endometriotic Nodule

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.

OP14.09: Symptoms and sonographic findings of women with bladder endometriosis

OP14.09: Symptoms and sonographic findings of women with bladder endometriosis

Total laparoscopic bladder resection in the management of deep endometriosis: "take it or leave it." Radicality versus persistence.

Bladder endometriosis (BE) is the most common external site of deep-infiltrating endometriosis (DIE) affecting the urinary tract. Frequently associated with other DIE lesions, it can be strongly related to a ventral spread of adenomyosis. Possible symptoms are urinary frequency, tenesmus and hematuria, and they are frequently related to DIE of the posterior and lateral compartment. Hormonal therapy can be used in non-symptomatic patients; conversely, in other cases surgical treatment is the management of choice. Retrospective cohort study of a series of consecutive patients treated between September 2004 and December 2017 in a tertiary care referral center. Only full-thickness detrusor involvement was considered as BE. All patients underwent laparoscopic bladder resection with concomitant radical excision of DIE. BE was found in 264 patients and was associated with simultaneous bowel DIE requiring bowel resection in 140 patients (53%). Twenty-five patients (9.5%) had associated obstructive ureteral signs requiring ureteroneocystostomy. Mean hospital stay and time of catheter removal were 9.7 and 9.1days, respectively. Postoperative major complications (< 28days) were observed in 19 patients (7.2%). Follow-up was performed at 1, 6 and 12months after surgery, with a 2.3% recurrence rate observed. Laparoscopic partial cystectomy for BE is a feasible and safe technique, and experienced laparoscopic surgeons should consider it the gold standard treatment. Surgical eradication leads to excellent surgical outcomes in terms of reduction of symptoms and recurrence rates, considering the need to maintain an adenomyotic uterus for fertility purposes.

Endometriosis of the Urinary Bladder and Ureter: A Review and Update of the Literature

Endometriosis of the urinary bladder and / or ureter are diseases that may occur alone or in association with endometriosis elsewhere in the pelvis or other sites of the body in women between the 2nd decades of life and the fifth decades of their lives typically in women who are menstruating but endometriosis of urinary bladder may occur / present in post-menopausal women on very rare occasions or in women with a past history of treatment for endometriosis elsewhere. Endometriosis of the urinary bladder and / or endometriosis of the ureter are uncommon diseases which tend to be reported sporadically globally. Endometriosis of the urinary bladder and / or ureter may be asymptomatic in some patients but other cases of endometriosis of the urinary bladder / and or ureter tend to present with non-specific symptoms including: suprapubic pain, urinary frequency and urgency, loin pain, dyspareunia, dysmenorrhoea, cyclical dysuria, and other non-specific symptoms including loin pain and infertility. A high-index of suspicion is required in order to diagnose the disease early with utilization of (a) various radiology imaging including ultrasound scan of pelvis and urinary tract, computed tomography scan of pelvis and urinary tract, or magnetic resonance imaging (MRI scan of pelvis and renal tract, (b) laparoscopy and biopsy of the endometriosis lesion for histopathology examination including immunohistochemistry studies of the specimen, (c) cystoscopy examination for further assessment. Diagnosis of endometriosis of the urinary bladder and / or ureter tends to be confirmed by pathology examination finding of endometrial glands and stroma in the excised or biopsy specimen and immunohistochemistry staining studies tend to exhibit the following features: (a) the endometrial stromal cells of endometriosis tend to stain positively upon immunohistochemistry staining for CD 10; (b) the glandular component of endometriosis does exhibit positive nuclear staining for p63; (c) the glandular component of endometriosis also stains positively for: CK7, ER oestrogen receptor, PR progesterone receptor; (d) endometriosis specimens also usually stain positively for: CA125. Treatment for endometriosis of bladder and or ureter could be conservative with inclusion of hormonal treatment, pain relief, and medications to reduce urinary bladder symptoms and this tends to be effective in many cases but recurrences tend to be higher in most cases in comparison with surgical treatment. Some of the surgical treatment for endometriosis of urinary bladder includes partial cystectomy ensuring completed excision of the endometriosis lesion or submucosal excision of the urinary bladder endometriosis lesion but leaving an intact urinary bladder mucosa. Surgical treatment of endometriosis of the ureter tend to involve (a) complete excision of the endometriosis segment of the ureter and end-to end ureteric anastomosis, or excision of the endometriotic ureter segment with either Boari-flap ureteric anastomosis to the urinary bladder or Psoas hitch anastomosis. Complication may occur following various treatment options adopted for the disease of the ureter and urinary bladder including recurrence, urinary urgency and urge incontinence, urinary stress incontinence, ureteric stenosis / stricture, vesico-ureteric reflux and these complications need to be treated and a long-period of follow-up would be required in order to also diagnose the late complications of the disease. Surgical excision surgery in the developed countries tend to be undertaken by the laparoscopic technique but in the developing countries that do not have facilities for laparoscopic surgery the open technique would tend to be adopted for all surgical treatment options of the disease.

Laparoscopic Partial Bladder Cystectomy for Bladder Endometriosis: A Combined Cystoscopic and Laparoscopic approach

Laparoscopic Partial Bladder Cystectomy for Bladder Endometriosis: A Combined Cystoscopic and Laparoscopic approach

Bladder Endometriosis: Evaluation in MRI of the Involvement of the Posterior Inferior Wall

Bladder Endometriosis: Evaluation in MRI of the Involvement of the Posterior Inferior Wall

Endometriosis of the Appendix: When to Predict and How to Manage—A Multivariate Analysis of 1935 Endometriosis Cases

To evaluate appendiceal endometriosis (AE) prevalence and risk factors in endometriotic patients submitted to surgery. A retrospective cohort study. A tertiary level referral center, university hospital. One thousand nine hundred thirty-five consecutive patients who underwent surgical removal for symptomatic endometriosis. Electronic medical records of patients submitted to surgery over a 12-year period were reviewed. We assessed any correlation between demographic, clinical, and surgical variables and AE. In our center, appendectomy was performed using a selective approach. Appendix removal was performed in case of gross abnormalities of the organ, such as enlargement, dilation, tortuosity, or discoloration of the organ or the presence of suspected endometriotic implants. AE prevalence was 2.6% (50/1935), with only 1 false-positive case at gross intraoperative evaluation. In multivariate analysis using a stepwise logistic regression model, independent risk factors for AE were adenomyosis (adjusted odds ratio [aOR] = 2.48; 95% confidence interval [CI], 1.32-4.68), right endometrioma (aOR = 8.03; 95% CI, 4.08-15.80), right endometrioma ≥5 cm (aOR = 13.90; 95% CI, 6.63-29.15), bladder endometriosis (aOR = 2.05; 95% CI, 1.05-3.99), deep posterior pelvic endometriosis (aOR = 5.79; 95% CI, 2.82-11.90), left deep lateral pelvic endometriosis (aOR = 2.11; 95% CI, 1.10-4.02), and ileocecal involvement (aOR = 12.51; 95% CI, 2.07-75.75). Among patients with endometriosis submitted to surgery, AE was observed in 2.6%, and it was associated with adenomyosis, large right endometrioma, bladder endometriosis, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement.

Bladder Endometriosis in a Background of Uterine Leiomyomas

Bladder Endometriosis in a Background of Uterine Leiomyomas

Combined transurethral resection and laparoscopic paritial cystectomy for the treatment of bladder endometriosis: A case report

Combined transurethral resection and laparoscopic paritial cystectomy for the treatment of bladder endometriosis: A case report

Rare conditions mimicking bladder endometriosis

Benign conditions of the bladder such as cystitis cystica and Xanthogranulomatous cystitis (XC) are chronic inflammatory lesions which are usually rare in incidence. Here, we report 2 case reports wherein both the patients were diagnosed as bladder endometriosis for which segmental resection and partial cystectomy were done by the minimally invasive approach. Post-operative pathological examination revealed the lesions as cystitis cystica in one case and XC in another. To the best of our knowledge, this case of cystitis cystica mimicking as the bladder endometriosis is the 2nd case reported in the literature and case of XC forming a tumorous lesion is the 29th to be reported in the world literature.

Total Laparoscopic Hysterectomy for Endometriosis and an Arteriovenous Malformation

To show laparoscopic management of an arteriovenous malformation in a patient with deep pelvic endometriosis DESIGN: A step-by-step explanation of the surgery using an instructive video. Hautepierre University Hospital, Strasbourg, France. We describe the case of a 37-year-old patient presenting with deep pelvic endometriosis and a uterine arteriovenous malformation. Deep pelvic endometriosis was diagnosed during a tubal ligation in 2015. Laparoscopy also showed some pelvic varicosities. Hysteroscopy was performed to increase the diagnostic precision. Huge blood vessels with an arterial pulse on the anterior wall of the uterus were found. The endometriosis of the patient was very symptomatic; she suffered from dysmenorrhea, menorrhagia, intense dyspareunia, and dyschezia. Magnetic resonance imaging indicated a large arteriovenous shunt in the anterior part of the uterus and bladder endometriosis. After a pluridisciplinary medical staff meeting, we decided to begin treatment with luteinizing hormone-releasing hormone analogs. Then, she underwent embolization of the arteriovenous malformation, which produced regression of the lesions as indicated by reevaluation with magnetic resonance imaging. We decided to perform laparoscopic hysterectomy. Evaluation of the abdominal cavity showed diaphragm endometriosis, deep pelvic endometriosis, and the arteriovenous malformation. We started with left ureterolysis and opening of the rectovaginal septum. After that, we radically dissected the left side of the uterus with a left oophorectomy and then the right side, conserving the ovary. Then, we shaved the bladder for endometriosis removal. To finish, we performed a right salpingectomy with a right ovariopexy, vaginal closure, and coagulation of the diaphragm's nodules. The patient agreed to record and publish the surgery, and the local institutional review board gave its approval. To conclude, preoperative embolization of the arteriovenous shunt improves surgery, avoiding excessive bleeding and permitting easier radical hysterectomy for deep pelvic endometriosis. Similar cases have been published [1], but to our knowledge, our video is the first regarding this subject. It appears that embolization can fail, but hysterectomy remains the gold standard treatment [2].

“When You Hear Hoofbeats, Think of Horses, Not Zebras:” A Case of Bladder Endometriosis in Menopause

“When You Hear Hoofbeats, Think of Horses, Not Zebras:” A Case of Bladder Endometriosis in Menopause