Endometriosis Of Urinary Bladder Research Articles

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

<strong>Background:</strong> 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. <strong>Case Presentation:</strong> 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. <strong>Conclusion:</strong> 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-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.

Primar Urinary Bladder Endometriosis: Laparoscopic Approach towards Therapeutic Mapping

Endometriosis of genital tract consists a controversial entity arising from current bibliography. Many conducted studies suggested a variety of pathophysiologic mechanisms in order to establish proper diagnosis and treatment. In many cases development of endometrial tissue outside endometrial cavity, can lead to depiction of physical symptomatology with unexpected clinical route. Besides, dysmenorrhea, dyspareunia and decrease of fertility capability, endometriosis can infiltrate many intraperitoneal organs such as urine bladder, rectum, or even mesenterium and lungs. Primary bladder endometriosis represents a very rare entity among female reproductive patients. Ultimate scope remains fertility preservation and increase of patient’s quality of life. Aim of our study reflects assiduous diagnosis and depiction of proper therapeutic strategy

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.

Standard Approach to Urinary Bladder Endometriosis

Study ObjectiveUrinary endometriosis accounts for 1% of all endometriosis where the bladder is the most affected organ. Although the laparoscopic removal of bladder endometriosis has been demonstrated to be effective in terms of symptom relief with a low recurrence rate, there is no standardized technique. Partial cystectomy allows the complete removal of the disease and is associated with low intra- and postoperative complications. Here we describe a stepwise approach to a rare case of a large endometriosis nodule affecting the trigone of the urinary bladder. DesignStep-by-step video explanation of a large endometriotic nodule excision (Canadian Task Force classification III). SettingIRCAD AMITS – Barretos | Hospital Pio XVI. The video was approved by the local institutional review board. PatientA 31-year-old woman. InterventionLaparoscopic approach for bladder endometriosis. Measurements and Main ResultsWe present a case of a 31-year-old woman who complained of dysuria and hematuria with a bladder nodule of 3 cm affecting the bladder trigone. Laparoscopic complete excision of the nodule was performed. Laparoscopy began with full inspection of the pelvic and abdominal cavity. Vaginal examination under laparoscopic view helped to determinate the dimensions of the bladder nodule. Strategy consisted of bilateral dissection of the paravesical fossae and the identification of both uterine arteries and ureters. The bladder was slowly dissected from the uterine isthmus and was intentionally opened, thus helping the surgeons to identify the lateral and lower limits of the nodule and its proximity to both ureters. Bilateral double J stents were previously placed to guide the excision and further suture. Once the nodule was removed, the remaining wall consisted of the lower aspect of the trigone, both medial lower parts of the ureter, and the apex of the bladder. Suturing was performed in 2 steps. A simple monofilament interrupted suture was applied vertically at the lower wall between both ureters. The same technique was applied horizontally on the bladder dome. Pressure test demonstrated adequate correction. The patient was discharged 2 days later with a bladder catheter and double J stent. After 15 days, both indwelling catheter and ureteric stent were removed, and patient was submitted to a cystogram where no leakage was found. If a leakage had been found on the cystogram, the bladder should be allowed an additional week of continuous drainage. Early follow-up demonstrated a lower bladder capacity that was resolved within 6 months. After a 1-year follow-up the patient had no symptoms and demonstrated no recurrence. She is now 20 weeks pregnant with no need of assisted reproductive methods. ConclusionThe technique showed in the video demonstrates the feasibility of a laparoscopic approach for bladder endometriosis. Furthermore, the laparoscopic approach allowed the removal of the large nodule, reducing the risk of small bladder symptoms.

Primary clear cell adenocarcinoma derived from endometriosis of urinary bladder

s / Urological Science 26 (2015) 294e300 295 (p< 0.02) which was poor performance in facets of overall QoL(0.046), enjoying of life(p1⁄4 0.001), meaning of life(p1⁄4 0.01), time for leisure activity(p1⁄4 0.002). However, log of PSA showed lack of impact in QoL. Conclusion: Our data demonstrated the PSA values and trend of PSA value play an important role in determining QoL in Taiwanese PC patients. Which could provide information for clinician in decision making. The underlying reason is worth to explore in future. MP1-4: PRIMARY CLEAR CELL ADENOCARCINOMA DERIVED FROM ENDOMETRIOSIS OF URINARY BLADDER Chin-Wei Kuo, Jen-Sen Lin, Meng-Yi Yan, Heng-Chieh Chiang. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua,

Endometriosis localized to urinary bladder wall mimicking urinary bladder carcinoma.

Although endometriosis is a common disease in women of reproductive age, urinary system endometriosis is an exceedingly rare disease that may cause important clinical problems. In this paper we discussed a 42-year-old woman who had urinary bladder endometriosis misdiagnosed as urinary bladder tumor in imaging modalities. The diagnosis of endometriosis was made by histopathological examination of the operative material after partial resection of the urinary bladder. Urinary bladder endometriosis causes nonspecific signs and symptoms in many patients. In female patients presenting with unexplained urinary symptoms the differential diagnosis should include urinary bladder endometriosis that may mimic urinary bladder cancer and lead to difficulties in making definitive preoperative diagnosis.

Bladder Cancer: The Hormonal Dependence Enigma and a New Hormonal Player.

Dear Editor, Bladder cancer is considered to be a hormonal-independent malignancy. However, an increasing number of studies show that sex hormonesmight have an important role in the etiology or progression of specific urothelial carcinoma subtypes. The most important indication that bladder cancer might be influenced by sex hormone is that the incidence and risk of developing bladder cancer in men is notably greater comparing to women, even when established risk factors such as smoking, occupational exposure, and urinary tract infection are counterbalanced between the sexes. The effect of sex hormones in bladder tissues is documented during pregnancy and menopause where the bladder undergoes dramatic changes in structure, function, histology, and gene expression. Bladder tissues are shown to express androgen, estrogen, and progesterone receptors. Additionally, in animal models, estrogens are shown to inhibit and androgens to promote bladder cancer development even when carcinogenetic substances are used such as N-butyl-N-(4hydroylbutyl)nitrosamine [1]. Another indication of the hormonal contribution in bladder cancer development is the relatively lower risk of parous women to develop this malignancy compared to the nulliparous females. A human bladder tumor cell line, R198, was shown to develop under the effect of androgens while it regressed under the presence of estrogen [2]. Finally, there is also the report of a man who developed endometriosis of urinary bladder, after 5 years treatment with estrogen therapy for prostate cancer [3]. The lesion regressed after estrogen withdrawal, indicating a metaplasia potential of the urothelium under extreme changes of hormonal environment. Under these circumstances, we would like to report our experience of a 65-year-old woman treated for breast cancer who developed urothelial carcinoma at the trigone of the urinary bladder, 1 year after the onset of adjuvant hormonal therapy with third-generation non-steroidal aromatase inhibitor. The patient underwent modified radical mastectomy with ipsilateral axillary lymphadenectomy 4 years ago and subsequently chemotherapy (FEC and docetaxel) and radiotherapy. Three months after the onset of aromatase inhibitor treatment, the patient claimed to have aggravated hirsutism of both arms and no hair growth on the parietal skull following a pattern of androgenetic alopecia. A year since the onset of adjuvant hormonal therapy, a papillary protrusion was detected at the trigone of the urinary bladder. The histological report showed a non-muscle invasive low-grade papillary urothelial carcinoma, grade 1 by WHO-ISUP. One and a half year later, the patient was found to have bladder cancer relapse with the same histological urothelial tumor and the same androgenetic effects of the adjuvant hormonal therapy. The current hypothesis we propose is that the excessive androgen environment produced by the aromatase inhibitor in a postmenopausal woman with lack of the counterbalancing hormones (estrogen and progesterone) could contribute to the development of bladder cancer. There are some hypotheses which try to explain the hormonal dependence of bladder cancer and especially of the trigone of the urinary bladder. The trigone and the prostate have the same embryologic endodermic origin. This hypothesis is supported by the finding that the tumor cells of R198 cell line have some similar characteristics with human prostatic carcinomas [2]. Additionally, one of the ways that K. Ntzeros (*) :G. Louka Department of Urology, Hospital of Korinthos, Korinthos, Greece e-mail: konstantinos.ntzeros@gmail.com

Is the Incidence of Urinary Bladder Endometriosis Increasing? Figures from Finland

Objective: Urinary bladder endometriosis is a severe form of endometriosis often requiring surgery. The several cases treated at our hospital in recent years has led us to evaluate the incidence of urinary bladder endometriosis in Finland. Methods: We performed a register-based analysis of incidence of urinary bladder endometriosis. The patients were identified according to registered diagnosis and operation codes. Results: Six urinary bladder endometriosis cases were diagnosed at Oulu University Hospital during 1991–2007. These cases have been presented. The annual incidence, as evaluated from The Finnish Care Register HILMO, increased from 3.6 to 9.4 cases/1,000,000 females aged 15–49 years per year during 1996–1999 and 2004–2007, respectively, in Finland. Conclusion: There is an apparent increase in incidence of urinary bladder endometriosis in Finland. The low number of cases detected at Oulu University Hospital, and the limitations of the incidence evaluation based on the HILMO register, exclude the presentation of an accurate incidence. The results presented warrant further and careful evaluation of potential increases in urinary bladder endometriosis elsewhere.

Immunohistochemical characterization of primary urinary bladder endometriosis

British Journal of Hospital MedicineVol. 68, No. 4 Case ReportImmunohistochemical characterization of primary urinary bladder endometriosisKofi Atiemo, Mala M Mala, Shaikh Shafaque, Ghulam Nabi, Sam McClintonKofi AtiemoSearch for more papers by this author, Mala M MalaSearch for more papers by this author, Shaikh ShafaqueSearch for more papers by this author, Ghulam NabiSearch for more papers by this author, Sam McClintonSearch for more papers by this authorKofi Atiemo; Mala M Mala; Shaikh Shafaque; Ghulam Nabi; Sam McClintonPublished Online:8 Apr 2014https://doi.org/10.12968/hmed.2007.68.4.218AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail FiguresReferencesRelatedDetails 1 April 2007Volume 68Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 8 April 2014 Published in print 1 April 2007 Information© MA Healthcare LimitedPDF download

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.