Management Of Bladder Endometriosis Research Articles

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.

Robotic Assisted Laparoscopic Management of Bladder Endometriosis Arising from a Caesarean Section Scar

Robotic Assisted Laparoscopic Management of Bladder Endometriosis Arising from a Caesarean Section Scar

Междисциплинарный подход к лечению эндометриоза мочевого пузыря

Urinary endometriosis a rare condition accounting for 1-5.5% of all of the extragenital endometriosis locations. Bladder endometriosis is the most common form of urinary endometriosis, comprising 85% of cases. There is no single approach to treating bladder endometriosis patients with this pathology. Multidisciplinary collaboration between urologists and gynecologists aimed to develop an appropriate treatment strategy is essential in the management of bladder endometriosis. We report two cases of patients with different location of endometriotic lesions in the bladder, surgical strategy and collaboration between urologists and gynecologists at all stages of treatment.

Diagnosis and management of bladder endometriosis

Bladder endometriosis is defined as full-thickness infiltration of the detrusor; small sub-peritoneal implants and small nodules of the vesicouterine fold cannot be considered to be bladder endomet...

Bladder endometriosis: a summary of current evidence.

Bladder endometriosis is a specific form of endometriosis characterized by the presence of endometrial glands and stroma in the detrusor muscle. Such disease may involve different sites of the bladder, most frequently the base and the dome, with various grade of infiltration. Bladder nodules typically coexists with other localizations of deep pelvic endometriosis, resulting in a wide variety of abdominal and urinary symptoms that may be overlooked by clinicians. In spite of advances in understanding the genetic and molecular development of endometriosis, the clinical approach to bladder lesions is very challenging and may require the use of different diagnostic tools in order to set up a comprehensive diagnostic workup and direct towards the most appropriate treatment. The aim of this paper was to portray the state of art of diagnosis and management of bladder endometriosis, starting from the current evidence about epidemiology, pathophysiology, clinical signs and providing all the available strategies for medical and surgical treatment.

Management of bladder endometriosis with combined transurethral and laparoscopic approach.Follow-up of pain control, quality of life, and sexual function at 12 months after surgery

To describe the pre-surgical and post-surgical outcomes at one year in terms of recurrence of lower urinary tract symptoms, quality of life, and sexual function of a transurethral and laparoscopic combined approach in the treatment of bladder endometriosis. The au- thors performed a prospective observational study of 16 women affected by symptomatic bladder endometriosis at the University Hos- pitals of Cagliari, Padua, and Foggia. In all patients bladder nodule was excised with a transurethral and laparoscopic combined approach technique. Intensity of lower urinary tract symptoms (VAS score) were assessed pre- and post-operatively at one, six, and 12 months after surgery; quality of life (SF-36) and sexual functions (FSFI) were collected preoperatively and one year postoperatively. Operative time was 120.18 ± 15.77 minutes and mean blood loss was 65.12 ± 44.74. No intraoperative and postoperative complications and conversion laparotomy occurred. Intensity of lower urinary tract symptoms evaluated with VAS score were significantly lower after one, six, and 12 months postsurgery vs. presurgery (p < 0.001). The authors observed a significantly improvement in the quality of life and sexual functions in all patients at one year after surgery. This surgical approach is safe and simple in the treatment of bladder en- dometriosis, with low risks and optimal resolution of symptoms, and improvement of quality of life and sexual function.

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.

Successful surgical management of bladder endometriosis in a patient with infertility: A case report

Successful surgical management of bladder endometriosis in a patient with infertility: A case report

Diagnosis and Management of Bladder Endometriosis

Bladder endometriosis is defined as full-thickness infiltration of the detrusor; small sub-peritoneal implants and small nodules of the vesicouterine fold cannot be considered to be bladder endometriosis. In women with endometriosis, urinary tract involvement is rare (1% to 5% of cases) but the bladder is affected in 80% to 84% of these cases. Symptoms of bladder endometriosis are various and not specific: besides pain symptoms, patients may complain of urinary frequency, urgency, urge incontinence, dysuria, and hematuria. Although bladder endometriosis may be suspected at vaginal examination, the preoperative diagnosis is based on transvaginal ultrasonography and magnetic resonance imaging. Medical therapies may temporarily reduce the severity of symptoms related to the presence of vesical endometriosis; however, the symptoms may persist in cases of large bladder nodules or may recur after cessation of therapy. Surgery represents the gold standard for treatment of bladder endometriosis and laparoscopy should be preferred to laparotomy. Excision of bladder nodules may be performed either by partial-thickness resection or by partial cystectomy according to the size and depth of the infiltration of the lesions in the bladder wall. Persistent improvement of symptoms has been demonstrated at long-term follow-up, particularly when the lesions involve the vesical dome.

Laparoscopic partial cystectomy in the management of bladder endometriosis: A case report

Laparoscopic partial cystectomy in the management of bladder endometriosis: A case report

Laparoscopic Partial Cystectomy in the Management of Bladder Endometriosis: Report of Two Cases

Endometriosis is the proliferation of endometrial tissue outside the normal confines of the myometrium or uterine cavity. Endometriosis involving the urinary tract occurs in approximately 1% to 2% of cases. The bladder is affected in 80% of these patients. The diagnosis of vesical endometriosis is difficult, and it should be confirmed by cystoscopy with biopsy. Laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. Urinary bladder endometriosis may be treated surgically or medically with hormone-suppressive therapy. However, medical treatments usually are only palliative, and symptoms generally recur on discontinuation. We report our experience in two patients with vesical endometriosis who were managed successfully with cystoscopy-assisted laparoscopic partial cystectomy.