Urinary Tract Endometriosis Research Articles

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.

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.

10117 Urinary Tract Endometriosis: Literature Review from 1976 to 2023

10117 Urinary Tract Endometriosis: Literature Review from 1976 to 2023

Surgical Management of Endometriosis of the Bladder and Ureter

<h3>Study Objective</h3> To demonstrate a step-by-step approach for the surgical management of urinary tract endometriosis using conventional laparoscopy for partial cystectomy and robotic-assisted laparoscopy for ureteroneocystostomy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Academic tertiary referral center for endometriosis. <h3>Patients or Participants</h3> The first patient was a 38-year-old G3P3 with a history of hysterectomy presenting with dysuria had an MRI which revealed a T2 hypointense bladder nodule consistent with endometriosis. The second patient was a 25-year-old nulliparous woman with history of stage IV endometriosis with DIE into the bowel and both ureters causing subsequent hydronephrosis requiring bilateral ureteral stents and subsequently bilateral percutaneous nephrostomy tubes. <h3>Interventions</h3> In the first case, a cystoscopy was performed to confirm MRI findings of bladder lesion and to delineate borders and depth of invasion. Conventional laparoscopy was utilized to perform bilateral ureterolysis, bladder mobilization, partial cystectomy for complete excision of the lesion, and two-layered bladder closure. Use of indigo carmine assisted with ureteral orifice identification. In the second case, cystoscopy was performed with injection of ICG to assist with ureteral identification. After ureterolysis, distal ureteric obstruction due to extensive disease was confirmed on laparoscopy and ureteroscopy. Bilateral ureteroneocystostomy with placement of Double-J ureteral stents was performed using a robotic-assisted approach. Each patient had indwelling foley catheter for bladder decompression during recovery. <h3>Measurements and Main Results</h3> Both patients had an uneventful postoperative course. A postoperative retrograde cystogram confirmed adequate repair prior to removal of each foley catheter. Patient two had office stent removal 6 weeks postoperative. <h3>Conclusion</h3> Endometriosis is an increasingly common condition. It is important for gynecological surgeons to have the proper understanding of anatomy, surgical technique, and multidisciplinary care needed with urology for safe and complete excision of bladder and ureter endometriosis.

SC106 - Urinary tract endometriosis: how to predict and prevent recurrence after primary surgical excision

SC106 - Urinary tract endometriosis: how to predict and prevent recurrence after primary surgical excision

A Review of Urinary Tract Endometriosis.

To describe the presenting signs and symptoms of patients with urinary tract endometriosis (UTE), appropriate workup, and to review medical and surgical therapies for symptom palliation and definitive management. UTE is a condition that clinicians should maintain a high index of suspicion for, as symptoms can be easily misdiagnosed from other causes. Surgical resection of implants appears to offer safe and durable symptom relief. Urinary tract endometriosis may present with symptoms overlapping with interstitial cystitis, nephrolithiasis, bladder overactivity, or recurrent urinary tract infections, and may or may not be cyclical in nature. Cyclical gross hematuria is considered pathognomonic, though final diagnosis must be made after a pathologic review. Without proper diagnosis and treatment, consequences such as silent renal loss from asymptomatic obstruction may result. After the diagnosis is made, initial therapy can be undertaken with hormonal treatment to palliate symptoms (most commonly in the form of combined oral contraceptives), followed by surgical resection for a definitive treatment option.

Urinary Tract Endometriosis: How to Predict and Prevent Recurrence after Primary Surgical Excision

To investigate the clinical and surgical predictors of urinary tract endometriosis (UTE) relapse. Retrospective single institutional study. Italian multidisciplinary referral center for endometriosis. Consecutive patients affected by UTE and surgically treated between January 2016 and March 2020. Surgical excision for UTE. Uni- and multivariate logistic regression analyses were fitted to evaluate clinical and surgical predictors of recurrence. A total of 105 female age-reproductive patients were enrolled. Median age was 32 years (interquartile range, 24-37). Ureteral involvement was recorded in 53 patients (50.5%), being unilateral and bilateral in 46 patients (43.8%) and 7 patients (6.7%), respectively. Bladder involvement occurred in 52 patients (49.5%). Open surgical approach was performed in 24 cases (22.9%), whereas 30 patients (28.5%) and 51 patients (48.6%) were treated with laparoscopic and robot-assisted approach, respectively. Overall, 53 patients (50.5%) received adjuvant hormonal therapy. At a median follow-up of 39 months (interquartile range, 22-51), 30 patients (28.6%) experienced disease relapse, with 14 recurrences (13.3%) recorded at the level of the urinary tract. At multivariable analysis, age at first surgery <25 years (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.10-1.84; p=.02) and the presence of a concomitant autoimmune disease (OR, 1.45; 95% CI, 1.24-2.17; p=.02) were found as predictors of deep infiltrating endometriosis recurrence, whereas adjuvant postsurgical therapy showed a protective role (OR, 0.83; 95% CI, 0.53-0.98; p=.01). Young age (<25 years) and the presence of autoimmune diseases were significant predictors for the development of disease recurrence, whereas adjuvant hormonal therapy showed a protective role.

Cystoscopic-guided Robotic Resection of Bladder Trigone Endometriosis Nodule with Ureteral Preservation

To demonstrate tips and tricks for the successful execution of robotic-assisted resection of a large bladder trigone endometriosis nodule while preserving the ureters. Stepwise demonstration with narrated video footage. An academic tertiary care hospital. Our patient is a 36-year-old G0P0 with a symptomatic full-thickness ill-defined nodule located in the posterior wall and trigone of the urinary bladder with anterior cul-de-sac endometriosis. Urinary tract endometriosis is a rare entity occurring in 1% of women with endometriosis and may involve the bladder and/or the ureters [1]. Bladder endometriosis (BE) frequently coexists with endometriosis in other locations such as the ovaries or peritoneum. Frequently seen lower urinary tract symptoms of BE include hematuria, frequency, and dysuria [2]. Previous literature has demonstrated the feasibility of a laparoscopic approach to BE in the trigone. However, there has yet to be any publications investigating the feasibility of robotic resection of bladder trigone endometriosis [3]. Cystoscopy was first performed, and the large mid-trigonal endometriosis nodule was noted to be extending within millimeters of the ureteral orifices. Bilateral ureteral orifices were identified, and double-J ureteral stents were sequentially guided up to the kidneys. The peritoneum lateral to the bladder bilaterally was incised to better define the edges of the bladder. Next, bilateral distal ureters were dissected out circumferentially, and the dissection was carried distally to the posterior bladder wall. Flexible cystoscopy with Firefly technology was then utilized to define the precise location and extent of the trigonal nodule to minimize removal of uninvolved bladder tissue and preserve the ureters. Using cystoscopic guidance, the dissection was first carried through the serosal and muscular layers, and once the circumference of the nodule had been clearly defined, we proceeded with the mucosal layer. The bladder lumen was entered, and the nodule was meticulously excised to avoid injury to the intramural ureters as the dissection was carried distally. We were able to preserve bilateral ureters despite the close proximity to ureteral orifices and also maintain enough bladder tissue for bladder closure. Once the resection of the trigonal nodule was completed, running 3-0 V-loc sutures were utilized in a 2-layer closure. The patient was discharged in 1 day with a Foley catheter and ureteral stents with reports of minimal pain. A cystogram at 10 days after the surgery was negative for leak, and the Foley catheter was removed. The ureteral stents were subsequently removed at 6 weeks after the surgery, and follow-up renal ultrasound demonstrated no hydronephrosis. Tips and tricks: (1) Utilizing robotic assistance in conjunction with cystoscopy aids the surgeon in precisely defining the boundaries of an endometriosis nodule and ureteral identification. (2) The precise dissection permitted by robotic-assisted surgery leads to greater tissue preservation of the bladder with complete endometriosis resection [4-6]. (3) Three-dimensional visualization provides depth of tissue analysis, which allows the surgeon to delicately dissect several centimeters of intramural ureter in the bladder wall and trigone. (4) Cystoscopy with Firefly technology guidance permits more precise localization compared with white light during dissection of the bladder nodule [7,8]. (5) The articulating instrumentation in the robotic surgical platform enables fine suturing technique [9,10]. Robotic-assisted resection of bladder trigone endometriosis with cystoscopic guidance may offer a precise and delicate dissection of large bladder trigone endometriomas, thus possibly providing optimal bladder trigone and ureteral preservation.

Accuracy of transvaginal ultrasound and magnetic resonance imaging for diagnosis of deep endometriosis in bladder and ureter: a meta-analysis

This meta-analysis aimed to determine the accuracy of transvaginal ultrasound (TVS) and pelvic magnetic resonance imaging (MRI) in diagnosing urinary tract endometriosis (UTE). A comprehensive search of the Pubmed and Embase was conducted between January 1989 and June 2020. Studies that described the accuracy of MRI or TVS for the diagnosis of UTE using surgical data as the reference standard were included. Of the 913 citations identified, 23 studies were analysed. For detection of endometriosis in bladder endometriosis (BE), the overall pooled sensitivities of TVS and MRI were 72% and 68% respectively, and their specificities were 99% and 100% respectively. For detection of endometriosis in the ureteral endometriosis (UE), the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. In conclusion, both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective. Besides, pelvic MRI and TVS are more accurate for predicting UTE localised in the ureter than bladder, especially in terms of sensitivity. IMPACT STATEMENT What is already known on this subject? Previous studies have confirmed high diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) on bladder endometriosis (BE) respectively. However, high heterogeneity was found for both sensitivity and specificity and no meta-analysis has yet been performed to test the diagnostic value of TVS and MRI for ureteral endometriosis (UE). What the results of this study add? In this meta-analysis, we firstly confirmed high diagnostic value of TVS and MRI on UE respectively. For detection of UE, the overall pooled sensitivities of TVS and MRI were 97% and 87% respectively, and their specificities were both 100%. What the implications are of these findings for clinical practice and/or further research? Early preoperative diagnosis and accurate understanding of the widespread distribution of endometriosis are prerequisites for radical surgical in UTE. In the present study, we updated the previous results on the accuracy of TVS and MRI for the diagnosis of BE and firstly confirmed high diagnostic value of TVS and MRI on UE. Both TVS and MRI provide good accuracy with specific strong points in diagnosing UTE and seem useful first-line methods from a clinical perspective.

Urinary Tract Endometriosis: A Multidisciplinary Fight Against a Silent Enemy

To demonstrate the safety and feasibility of laparoscopic robotic assisted approach to urinary tract endometriosis. This is an educational video to explain the main steps of robotic assisted ureteroneocystostomy owing to endometriosis. Tertiary care university hospital. A patient written consent was obtained on March 9, 2021. The local institutional review board confirmed that the video met the ethical criteria. Laparoscopic robotic assisted resection of uterosacral ligament endometriotic nodule, left terminal partial ureterectomy, partial cystectomy, and ureteroneocystostomy. This video shows a stepwise approach to laparoscopic robotic assisted urinary tract endometriosis management demonstrating its feasibility and safety. Urinary tract endometriosis affect only the 0.3% to 6% of women affected by endometriosis, among which the most common localization is the bladder (84%-90%) [1]. The ureteral compression is rare but can lead to obstruction up to silent loss of renal function [2], which is one of the main factors to take into account in the management of this disease [3].

A0631 - Clinical and surgical predictors of urinary tract endometriosis after primary surgical treatment: A single high-volume centre experience

A0631 - Clinical and surgical predictors of urinary tract endometriosis after primary surgical treatment: A single high-volume centre experience

Periureteralna endometrioza - prikaz slučaja

The aim of this paper is to present a rare case of periureteral endometriosis in an adult patient as well as to emphasize the importance of suspected urinary tract endometriosis and the important role of CT of the pelvis in making an accurate diagnosis of this rare disease. The authors present a rare case of periureteral endometriosis with symptoms primarily arising from ovarian endometriosis. The diagnosis of periureteral endometriosis was determined on the basis of CT of the small pelvis and abdomen.

Laparoscopic Management of Endometriosis with Deep Infiltration of the Bladder

Study Objective To discuss and review surgical management of endometriosis with bladder invasion through a surgical case. Design Single patient case report. Setting Academic hospital. Patients or Participants 38yo G3P3 with pelvic pain, dysuria, adenomyosis and urinary tract endometriosis desiring definitive management. Interventions Patient underwent robotic-assisted laparoscopic lysis of adhesions, resection of urinary tract endometriosis with bladder dome involvement and hysterectomy. During resection, paravesical and vesicouterine spaces were developed, the ureter was identified, and the bladder dome lesion circumscribed and excised, followed by detrusor repair. Measurements and Main Results The patient was discharged home the same day with a urinary foley catheter for two weeks. She had an uncomplicated post-operative course with improvement in her symptoms. Conclusion This video demonstrates the robotic resection of deep infiltrating endometriosis with urinary tract involvement and highlights techniques to avoid injury to underlying structures. To discuss and review surgical management of endometriosis with bladder invasion through a surgical case. Single patient case report. Academic hospital. 38yo G3P3 with pelvic pain, dysuria, adenomyosis and urinary tract endometriosis desiring definitive management. Patient underwent robotic-assisted laparoscopic lysis of adhesions, resection of urinary tract endometriosis with bladder dome involvement and hysterectomy. During resection, paravesical and vesicouterine spaces were developed, the ureter was identified, and the bladder dome lesion circumscribed and excised, followed by detrusor repair. The patient was discharged home the same day with a urinary foley catheter for two weeks. She had an uncomplicated post-operative course with improvement in her symptoms. This video demonstrates the robotic resection of deep infiltrating endometriosis with urinary tract involvement and highlights techniques to avoid injury to underlying structures.

Robotic-Assisted Laparoscopic Treatment of Bladder Endometriosis

<h3>Study Objective</h3> To show the combined surgical approach of cystoscopy and robotic-assisted laparoscopy for a complete and safe resection of bladder endometriosis. <h3>Design</h3> A clinical case and surgical cystoscopic and robotic approach of bladder endometriosis resection demonstrated by video. <h3>Setting</h3> Bladder endometriosis is defined as the presence of endometrial glands and stroma in the detrusor muscle and is the most common site affected in urinary tract endometriosis. Surgical treatment should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. Robotic-assisted laparoscopy provides advantages as 3D visualization and facilitation of suturing techniques compared to conventional laparoscopy. <h3>Patients or Participants</h3> A 32-year-old nulliparous patient, complaining of sensation of incomplete emptying of the bladder and dysuria, with worsening in the menstrual period. Patient had been using combined oral contraception but reported worsening of symptoms since she stopped the use in 2019. During letrozole treatment for infertility she discovered a bladder nodule of probable endometriotic origin. MRI showed signs of deep endometriosis in the vesicouterine recess, with infiltration of the anterior uterine serosa and left round ligament, measuring around 3.0 × 2.0 × 0.9 cm, in addition to the nodular lesion that infiltrates and retracts the upper wall of the bladder, projecting to the bladder lumen of 3.8 × 2.5 × 2.1 cm. <h3>Interventions</h3> It was performed cystoscopy and bilateral double-J catheter passage, followed by robotic-assisted laparoscopic resection of bladder endometriosis with partial cystectomy. Surgical field was prepared and the paravesical accessed to the bladder nodule. Bladder was sutured with barbed thread and surgical specimen removed by colpotomy. <h3>Measurements and Main Results</h3> Anatomopathological exam confirms endometriosis. <h3>Conclusion</h3> Endometriosis of urinary tract can have an appropriate surgical resection by laparoscopic management with or without robotic assistance. Having knowledge of the surgical technique and the platform allows a safe and complete resection, minimizing complications.

Robotic Surgery for Ureteral Endometriosis with End-to-End Anastomosis

<h3>Study Objective</h3> To demonstrate the technique, landmarks and surgical steps of a robot-assisted end-to-end ureteral anastomosis <h3>Design</h3> Sequential demonstration of clinical history and surgical approach with narrated video footage. <h3>Setting</h3> Urinary tract endometriosis occurs in 1–5.5% of women with endometriosis; it involves the bladder in 70–85% of cases and the ureter in 9–23% of the cases. In 90% of patients, ureteral endometriosis (UE) is associated with other sites affected by endometriosis. The diagnosis of UE is difficult since the disease may be clinically silent in 30% of patients, or it may be associated with non- specific symptoms, such as dysmenorrhea, dyspareunia and non- menstrual pelvic pain. Sometimes progressive upper urinary tract obstruction leads lost the kidney function. Patients may temporally benefit from medical therapy, but surgery is needed when ureteral obstruction is present. Surgical options are conservative ureterolysis or radical approaches, such as ureterectomy with end-to-end anastomosis or ureteroneo- cystostomy performed in relation to the type, site and length of ureteral involvement. <h3>Patients or Participants</h3> A 60-year-old woman with pelvic pain refractory to medical therapy, with a previous MRI showing signs of left pyelocaliceal dilation. <h3>Interventions</h3> Diagnosis of an endometriotic lesion involving the left ureter with the use of pelvic MRI. Surgical approach with robot-assisted laparoscopy, performing the ureterolysis and an end-to-end ureteral anastomosis. <h3>Measurements and Main Results</h3> Patient was good after the surgery, showing an important improvement in the pelvic pain. The double J stent was maintained for 30 days and after this period was removed, without complications. The urination remained normal after the removal. <h3>Conclusion</h3> Ureteral endometriotic lesion cases are challenging due to its requirement of a high skilled surgical treatment. The imaging exams as RMI are extremely important for the surgical planning. The robot-assisted laparoscopy is a great option for the treatment of these cases, but it requires an arduous and specific training and an experienced team, due to its complexity.

Robotic Approach to Ectopic Endometriosis in a Patient with Duplicated Ureters

<h3>Study Objective</h3> To demonstrate a minimally invasive approach to excision of ectopic urinary tract endometriosis in a patient with an anomalous duplicated left renal collecting system. <h3>Design</h3> Case report surgical video. <h3>Setting</h3> Single center academic institution. <h3>Patients or Participants</h3> A 45-year-old female with a history of endometriosis with prior robotic hysterectomy and left salpingo-oophorectomy presented with worsening urge incontinence, flank and pelvic pain. Patient was referred after evaluation revealed a mass adjacent to the left ureterovaginal junction and bladder trigone. <h3>Interventions</h3> Initial cystoscopy revealed a left non-intrusive bladder mass near the left ureteral orifices. A 2 cm firm, fixed nodule in the left fornix of the vagina was excised. Endometriosis was confirmed on frozen section. Upon laparoscopic entry, anatomy was noted to be distorted due to extensive scarring in the left pelvic sidewall including the vaginal cuff and bladder. The posterior cul-de-sac, pararectal, and paravesical spaces were then dissected open, allowing for visualization of the intersigmoid recess and the double ureters encased in scar tissue. After creating two small windows to open the peritoneum, continued dissection proceeded laterally along the pelvic sidewall. En bloc endometriosis was noted on the left infundibulopelvic ligament, vaginal cuff, bladder, and ureters. The scarred peritoneum was excised by encircling the affected areas. Concomitant ureteral dissection ensued with simultaneous removal of endometriotic nodules at the vaginal cuff and ureterovaginal junction. The patient then had an uncomplicated right salpingo-oophorectomy. <h3>Measurements and Main Results</h3> The patient was discharged home on postoperative day one and had an overall uncomplicated postoperative course. Final pathology was consistent with endometriosis. At her post-operative appointment, the patient experienced complete resolution of her symptoms. <h3>Conclusion</h3> In a patient with a known history of endometriosis and a newfound bladder mass, ectopic endometriosis should be considered. Robotic surgical excision is an appropriate minimally invasive approach after adequate preparation.

Renal Endometriosis Mimicking a Malignancy—a Rare Case of Reno-Mullerian Fusion?

Endometriosis is a common gynaecological condition characterised by ectopic endometrial tissue growth beyond the uterine cavity. Urinary tract endometriosis represents only 1.2% of all cases, with renal endometriosis accounting for less than 1% of urinary tract involvement. An asymptomatic, 49-year-old, perimenopausal Irish female was found to have an incidental mass at the upper pole of the right kidney on imaging studies. Histological analysis was recommended to outrule a renal malignancy and an open radical nephrectomy was performed following multidisciplinary input. Histological analysis surprisingly revealed the presence of endometriosis and endosalpingiosis, accompanied by a significant smooth muscle component, which mimicked a renal neoplasm. The aetiology of renal endometriosis remains unclear. However, given the lack of a history of endometriosis and the absence of other foci of disease in this patient, together with the smooth muscle predominant phenotype, this may represent a case of reno-mullerian fusion or endometrial displacement during gestational development.

Clinical characteristics of urinary tract endometriosis: A one-year national series of 232 patients from 31 endometriosis expert centers (by the FRIENDS group)

ObjectiveTo review prospectively the clinical characteristics of patients suffering from urinary tract endometriosis (UTE) in France, in 2017. Study designWe conducted a prospective observational multicenter study including women managed surgically for UTE in 31 French endometriosis expert centers (FRIENDS group) from January 1, 2017 to December 31, 2017. We distinguished patient with isolated bladder endometriosis (“IBE”) or isolated ureteral endometriosis (“IUE”) and patients associating both locations (mixed locations “ML”). Surgeons belonging to FRIENDS group enrolled patients by filling a 24 items questionnaire the day of the surgery and 6 weeks later. Data on the locations of UTE, preoperative assessment, urinary symptoms and associated pelvic locations were collected in a single anonymized database. ResultsA total of 232 patients from 31 centers were included. IBE concerned 82 patients (35.3%), IUE 126 patients (54.4%) ML 24 patients (10.3%). 111 patients reported urinary symptoms (47.8%). IUE was more often asymptomatic than the rest of the locations (59.5% versus 43.3%, OR 1,92, p = 0.017). Associated deep infiltrating endometriosis (DIE) lesions were found in 193 patients (83.1%). IUE was significantly associated with other DIE lesions (82.5% versus 66%, OR2.4, p = 0.006), particularly with rectum or sigmoid nodules (57.1% versus 36.8%, OR 2.3, p = 0.002) and retrocervical space nodules (31.7% versus 19.8%, OR 1.9, p = 0.05). ConclusionOur study reports the second largest series of patients operated from a UTE and shows that ureteral location seems more frequent, less symptomatic and more frequently associated to other DIE locations than bladder endometriosis.

Management of patients with urinary tract endometriosis by gynecologists

Objective: The aim was to report the postoperative outcomes of urinary tract endometriosis (UTE), which is a form of deep, infiltrative endometriosis, and to contribute to the literature by presenting our experience.Material and Methods: In the present study, patients who underwent surgery for endometriosis at our clinic between 2005 and 2019 and had a final pathological diagnosis of UTE were examined in detail. Patient information was retrospectively retrieved from the medical records. Data obtained pre-, peri-, and postoperatively were analyzed.Results: Mean age of the 70 patients included, according to the study criteria, was 32.73±7.09 years. Ureteral involvement alone was observed in 49% (n=34) of the patients, bladder involvement alone was observed in 24% (n=17) of the patients, and both bladder and ureteral involvement were observed in 27% (n=19) of the patients. Microscopic hematuria was detected in 16% (n=11) of the patients, whereas preoperative urinary tract findings, such as recurrent urinary tract infections, were detected in 19% patients (n=13). Of the patients, 56% (n=39) were identified with dyspareunia, 56% (n=39) with dysmenorrhea, and 30% (n=21) with pelvic pain. Visual analog scale score was significantly lower after the procedure (p<0.0001).Conclusion: Although postoperative results were typically considered positive, surgical method performed in deep infiltrative endometriosis should aim to preserve fertility, improve quality of life, and reduce the complication rate to a minimum.