Bladder Endometriosis Research Articles

Bladder endometriosis developed after long‐term estrogen therapy for prostate cancer

Bladder endometriosis developed after long‐term estrogen therapy for prostate cancer

Combined transurethral approach with Versapoint® and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up

When endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1-2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint(®) and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up. We performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint(®)). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o'clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE(®). The bladder hole was repaired with a continuous 3-0 monofilament two-layer suture. Operating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up. A combined transurethral approach with Versapoint(®) and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.

Multidetector Computed Tomography Virtual Cystoscopy: An Effective Diagnostic Tool in Patients With Hematuria

To evaluate the efficacy and the potential use of multidetector computed tomography virtual cystoscopy (MDCT-VC) in patients with gross hematuria. A total of 32 patients underwent MDCT-VC, cystoscopy, and a cytologic examination. The slice thickness of MDCT was 1 mm. Bladder distension was done with room air. The data were converted into 3-dimensional virtual reconstructive models. The data sets were reviewed independently by 2 experienced radiologists. Tumors confined to the mucosa, infiltrating the muscularis, and transmural tumors were distinguished. VC showed a sensitivity and specificity of 100%. The radiologic accuracy regarding T stage correlated in 87.5%. MDCT-VC identified 21 bladder lesions suspicious for bladder cancer in 18 patients. The histologic results showed 22 patients with bladder lesions, 18 were diagnosed with transitional cell carcinoma of the bladder, 3 had bladder endometriosis, and 1 had an infiltrating colon cancer. Four patients had concomitant carcinoma in situ lesions, which were not seen completely with MDCT-VC. However, cytology was positive in those cases. Ten patients did not have any tumor signs on VC and the subsequent conventional cystoscopy did not bring any change to the initial tumor-free diagnosis of VC. MDCT-VC combined with urine cytology is a good alternative to conventional cystoscopy for patients with painless gross hematuria. It should be used as a decision-making aid to identify patients who will benefit from additional cystoscopic examination. Future developments should focus on the visibility of sessile and carcinoma in situ lesions.

A successful case of laparoscopic partial cystectomy for bladder endometriosis

Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the uterus. About 1% of women with endometriosis have urinary tract implantations, and 84% of these cases involve the bladder. Abdominal partial cystectomy has been reported to treat urinary tract implantations, but laparoscopy has not previously been reported in Korea. We report a case of vesical endometriosis that was treated successfully with laparoscopic partial cystectomy.

Laparoscopic Extramucosal Partial Bladder Resection in a Patient with Symptomatic Deep-Infiltrating Endometriosis of the Bladder

Endometriosis is a complex disease, affecting the urinary tract, mainly the bladder, in 1% to 2% of cases. Thus far, partial cystectomy has been the treatment of choice for long-term relief of symptoms. Here, we describe the case of a 26-year-old patient with deep-infiltrating bladder endometriosis who was completely cured by laparoscopic extramucosal bladder resection. Diagnostic standards and factors affecting the rate of success for this additional option in endometriosis surgery are discussed.

Robotic Assisted Laparoscopic Treatment of Bowel, Bladder and Ureter Endometriosis – Report of Five Cases

Robotic Assisted Laparoscopic Treatment of Bowel, Bladder and Ureter Endometriosis – Report of Five Cases

Deep Bladder Endometriosis Seems Not To Be Different Pathologies According to the Existence or Not of Previous Uterine Surgery History

Deep Bladder Endometriosis Seems Not To Be Different Pathologies According to the Existence or Not of Previous Uterine Surgery History

Use of Advanced Bipolar Energy and Barbed Suture in Laparoscopic Excision of Bladder Endometriosis

Use of Advanced Bipolar Energy and Barbed Suture in Laparoscopic Excision of Bladder Endometriosis

Laparoscopic extramucosal partial bladder resection in a patient with symptomatic deep-infiltrating endometriosis of the bladder, adenomyosis uteri and asymptomatic deep-infiltrating endometrio-sis of the rectum

Laparoscopic extramucosal partial bladder resection in a patient with symptomatic deep-infiltrating endometriosis of the bladder, adenomyosis uteri and asymptomatic deep-infiltrating endometrio-sis of the rectum

Prevalence and Management of Urinary Tract Endometriosis: A Clinical Case Series

To report on the prevalence, surgical management, and outcome of urinary tract endometriosis (UTE) in a cohort of 221 patients undergoing laparoscopic surgery for severe endometriosis. UTE can cause significant morbidity, such as silent kidney or progressive renal function loss. Its frequency is underestimated and data on laparoscopic management are scarce. Between 2007 and 2010, 43 patients were eligible for this single-center, retrospective study. The inclusion criterion was the presence of UTE (ie, bladder and/or ureteral endometriosis). All patients were operated laparoscopically. The prevalence of UTE was 19.5% (43/221). There was no correlation between bladder and ureteral endometriosis (P >.05). Ureteral endometriosis was associated with patient's age (P <.01). Patients with bladder, but not ureteral, involvement complained more frequently about dysuria, hematuria, and urinary tract infections. Intraoperative and magnetic resonance imaging (MRI) findings revealed a moderate to good correlation. UTE was not associated with rectovaginal or bowel endometriosis, but rather with involvement of the uterosacral ligaments (P <.01). Twenty-two patients with bladder endometriosis were treated by mucosal skinning and 11 patients underwent partial cystectomy. Superficial ureteral excision was performed in 4 patients, whereas resection with ureteroureterostomy was done in 9 patients. There was no difference regarding the intra- and postoperative complications in patients with or without UTE. In severe pelvic endometriosis, involvement of the urinary tract is quite common. Laparoscopic management is feasible and safe. Because of the lack of specific symptoms, the preoperative diagnosis of ureteral endometriosis still remains a challenge. Pelvic MRI represents a useful preoperative diagnostic tool.

108 Robotic partial cystectomy for bladder endometriosis

108 Robotic partial cystectomy for bladder endometriosis

MR imaging of bladder endometriosis and its relationship with the anterior uterine wall: Experience in a tertiary referral centre

ObjectiveBoth the intraperitoneal seeding and the uterine-vesical extension theory have been proposed to explain the pathogenesis of bladder endometriosis. The aim of this study was to describe MR imaging findings of bladder endometriosis and involvement of the anterior uterine wall in a tertiary referral centre for endometriosis in a effort to improve diagnosis and help clarify the pathogenesis. MethodsIn a single-centre, retrospective study (2004–2009), 463 consecutive patients analysed for deep infiltrating endometriosis (DIE) were studied independently by two experienced readers for the presence of bladder endometriosis. MR studies revealing bladder endometriosis were then analysed in consensus for: location, size, signal intensity characteristics, uterine involvement, continuity with adenomyosis and presence of cysts. There was histopathologic correlation in 9 patients who had undergone partial bladder resection. ResultsBladder endometriosis was diagnosed in 32 patients on MR imaging (k=0.85). Most lesions showed heterogeneous isointensity compared to that of muscle on T2-weighed imaging, containing foci of high signal intensity, suggesting cystic ectopic endometrial glands. On T1-weighted imaging lesions showed heterogeneous isointensity with foci or small cysts, demonstrating high signal intensity, indicating hemorrhage, was observed. Uterine involvement was found in 94% of the lesions, with either “continuous” or “hourglass” configurations. Presence of contiguous adenomyosis was found in only 4 lesions. ConclusionsWith MR imaging, uterine involvement in bladder endometriosis is frequently found and in most cases located subserosally, suggesting extensive DIE, favouring the intraperitoneal seeding theory.

Polypoid endometriosis of the bladder during pregnancy mimicking urachal carcinoma

We report a case of polypoid bladder endometriosis in pregnancy. Diagnostic workup showed a vesicouterine well-vascularized polypoid mass, suspicious for malignancy. During pregnancy, the mass was surgically resected with safe oncological margins. Pathological examination of the resected specimen revealed pseudotumoral polypoid endometriosis of the bladder. We illustrate diagnostic pitfalls in the differentiation between bladder endometriosis during pregnancy and malignancy. As a result of pregnancy-related decidualization of vesical endometriosis, differentiation between this rare occurrence and malignant transformation is challenging.

UP-01.073 Bladder Endometriosis: Clinical, Diagnostic and Therapeutic Aspects

UP-01.073 Bladder Endometriosis: Clinical, Diagnostic and Therapeutic Aspects

Étude de faisabilité du traitement laparoscopique robot-assisté de lésions d’endométriose pelvienne profonde

Background Preliminary study of the feasibility of robot-assisted laparoscopy for deep pelvic endometriosis nodule resection. Patients and methods Between May 2009 and February 2010, we collected medical and surgical data about deep infiltrating endometriosis resections performed in our institution, using robot-assisted laparoscopy (DA VINCI Intuitive Surgical System ®). Results Six patients were included: four partial bladder and two uterosacral ligament resections. The median age was 29.5 years (24–48). All patients reported chronic pelvic pain, associated with urinary tract symptoms in case of bladder endometriosis. Before surgery, lesion mapping was performed using magnetic resonance imaging for all, and mechanical bowel preparation or double-j stenting were prescribed, depending on the endometriosis location. Surgical procedures median time was 173 minutes (156–244), and median length of stay was 3 days (2–5). Complete resection was possible in all cases. There was no conversion in classical laparoscopy or laparotomy, and no intraoperative complication. Pathology diagnosis of surgical pieces concluded to endometriosis lesion in all cases. Conclusion This study shows the feasibility of the robot-assisted laparoscopy in the resection of deep pelvic endometriosis, without increasing of surgical timing, blood loss or intraoperative complications.

Deep pelvic endometriosis: Limited additional diagnostic value of postcontrast in comparison with conventional MR images

To determine the value of postcontrast MR imaging (MRI) in cases of suspected pelvic endometriosis by assessing interobserver variability of MR imaging according to the endometriotic locations. This retrospective study included 158 patients with clinical suspicion of endometriosis who had undergone surgery after MRI between January 2004 and April 2009. Three radiologists with different degrees of experience were independently asked to determine the presence of rectosigmoid colon, vaginal, and bladder endometriosis using both conventional and a combination of conventional and postcontrast MRI. Descriptive analysis, ROC analysis and interobserver agreements (kappa values) were calculated. Rectosigmoid colon, vaginal, and bladder endometriosis was present in 65, 39 and eight patients, respectively. The accuracy of conventional assessment for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.2%, 74.1% and 96.8%, and 73.4%, 76.6% and 98.7%, and 86.1%, 88.6% and 99.4%, respectively. The accuracy of conventional and postcontrast MR images for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.8%, 78.5% and 98.1%, and 83.5%, 83.5% and 99.4%, and 87.3%, 89.2% and 99.4%, respectively. Interobserver variability of MRI using conventional MRI alone is excellent for the diagnosis of DPE. No significant benefit of intravenous gadolinium, rectal or vaginal administration has been demonstrated.

Outcomes of Surgical Management of Deep Infiltrating Endometriosis of the Ureter and Urinary Bladder

To report the outcomes of surgical management of urinary tract endometriosis and discuss the choice between conservative and radical surgery. We reviewed data concerning women managed for ureteral or bladder deep infiltrating endometriosis in 5 surgical departments participating in the CIRENDO prospective database. Preoperative data, surgical procedure data, and postoperative outcomes were analyzed. Data from 30 women pooled in the database showed 15 women presenting with ureteral endometriosis, 14 women with bladder nodules, and 1 with both types of lesions. Ureterolysis was performed in 14 cases; the ureter was satisfactorily freed in 10 of these. In 4 women over 40 years old, who were undergoing definitive amenorrhea, moderate postoperative ureteral stenosis was tolerated and later improved in 3 cases, while the fourth underwent secondary ureteral resection and ureterocystoneostomy. Primary ureterectomy was carried out in 4 women. Two cases of intrinsic ureteral endometriosis were found in 5 ureter specimens. Four complications were related to surgical procedures on ureteral nodules, and 2 complications followed the removal of bladder endometriosis. Delayed postoperative outcomes were favorable with a significant improvement in painful symptoms and an absence of unpleasant urinary complaints, except for one patient with prolonged bladder denervation. Conservative surgery, in association with postoperative amenorrhea, can be proposed in a majority of cases of urinary tract endometriosis. Although the outcomes are generally favorable, the risk of postoperative complications should not be overlooked, as surgery tends to be performed in conjunction with other complex procedures such as colorectal surgery.

Dienogest, a new conservative strategy for extragenital endometriosis: a pilot study

Extragenital endometriosis severely impairs the quality of life for affected women but its standard management has not yet been well established because of its relatively low incidence. As extragenital organs, intestine, followed by urinary tract, is the most common place affected by endometriosis, for which surgical treatment is sometimes difficult and accompanied by severe complications. Recently, dienogest, a novel progestin, has emerged as a new alternative for endometriosis, especially for endometriosis-associated pain. In this report, we presented four cases with rectosigmoidal and one with bladder endometriosis, treated with oral 2 mg/day dienogest for over 6 months. For all cases, the measurable extragenital lesions exhibited the reduction in their size after 10 to 11 months of use, accompanied with immediate relief of subjective symptoms related with extragenital lesions. This report suggests that dienogest can be a novel conservative alternative for extragenital endometriosis.

Laparoscopic Partial Cystectomy for Bladder Endometriosis

Bladder endometriosis is a rare pathological entity that must be suspected in patients suffering of deep infiltrating endometriosis specially when is associated to dysuria, increased micturition frequency, suprapubical pain and menuria. Bladder ultrasound is the first approach to identify this pathology that can be confirmed by pelvic MRI. Intravenous pyelography must be used to exclude the ureteral involvement. Laparoscopic partial cystectomy performed for bladder endometriosis in selected patients requires advanced laparoscopic skills including pelvic dissection, suturing and intracorporeal knot tying.

Endometriosis With Bladder Involvement

Endometriosis is a condition in which endometrial tissue is found outside of the uterus. The ectopic endometrial tissue may be found in a variety of places but commonly involves the peritoneal surfaces of the pelvis. Rarely implants of endometriosis can be seen in other areas such as the bladder and urinary tract. When conducting routine transvaginal sonography (TVS) on a woman in her late 40s with pelvic pain, a mass was noted in the bladder that was later confirmed as endometriosis via laparoscopic surgery. This case report demonstrates the appearance of bladder endometriosis on TVS and reviews its clinical presentation as well as pathophysiology.