European Journal of Obstetrics & Gynecology and Reproductive Biology
Bladder endometriosis: laparoscopic treatment and follow-up
Introduction
Bladder endometriosis is a very rare condition, representing <1% of all endometriosis cases [1], [2]. It was first reported by Judd [3], while the first cystoscopic description was given by Muller [4], and a first review of 200 cases was published in 1980 [5]. Endometriosis lesions of the urinary tract involve the bladder in 84% of cases [6]. As this condition is frequently associated with other forms of pelvic endometriosis, it cannot be considered as an independent form of the disease [7]. Although uncommon, this pathology is being reported in literature with increasing frequency, though much is still unknown about it. Diagnosis is often delayed as pathology symptoms appear to overlap with those of urinary tract infections, chronic urethral syndrome, overactive bladder, vulvodynia and interstitial cystitis and similar diseases in women [8]. When a bladder nodule is diagnosed, it has to be differentiated from bladder carcinoma, varices, papillomas or angiomas. For this reason, confirmation of diagnosis by cystoscopic biopsy should be attempted, even if it is often inadequate due to the submucosal or a thickness detrusor location of the lesion.
The pathogenesis is much debated. The major etiopathogenetic theories proposed in literature are: a development from Mullerian remnants in the vesicouterine septum [1], an extension of an adenomyotic nodule of the anterior uterine wall [9] and the most proposed transtubal menstrual reflux of endometrial cell with implantation on the peritoneum covering the bladder dome [6], [10], [11], [12]. Recent family and twin studies have also supported a prospective heritability of the disease, with a significant linkage to a locus on chromosome 10q26 [13]. Gene variants with effects on the disease predisposition have been supposed too, even if consequences have not yet been confirmed [13].
Many treatments have been proposed to cure this pathology. Medical therapy is considered only palliative as the symptoms generally recur after discontinuation [14]. In contrast, surgical treatment is generally considered effective, ensuring long-term relief in almost all cases. Eradication of the endometriosis is carried out with a partial cystectomy or with a resection of the nodule, as many recurrences of the disease are reported only after a transurethral resection [15], [16]. This intervention is generally performed by laparotomy. In 1993 and 1994, Chapron and coworkers [16], Nehzat and Nehzat [17] and doctors from other endoscope centres [18] published the first cases treated successfully with laparoscopy. Afterwards, they confirmed that, in skilled hands, the laparoscopic approach was safe and effective in the treatment of this pathology [19], [20], [21], [22]. Unfortunately, adequate laparoscopic suturing and knot-tying skills are essential when performing this surgery so the high learning curve and the rarity of the condition have limited its widespread use to a few experienced centres. Overall, insights from less eminent groups are warranted to validate the laparoscopic approach.
In this study, we aim to show the treatment outcome in women affected by bladder endometriosis who were operated in our unit. In order to disentangle the specific effects of the treatment modalities on endometriotic vesical lesions, we decided to include only women with deep nodules located in the bladder.
Section snippets
Materials and methods
Between March 2005 and 2007, women with deep vesical endometriosis referred to the Departments of Obstetrics and Gynaecology of University Hospitals “G. Martino” of Messina, “Paolo Giaccone” of Palermo and “San Paolo” of Milano, were respectively recruited. We considered a vesical disease exclusively when a full-thickness detrusor lesion was present. A preoperative assessment of the pathology was performed by vaginal examination, transabdominal and transvaginal ultrasound, cystoscopy, urine
Results
Eight women, with a mean age of 33.8 (range 30–37 years; S.D. = 2.5) and a mean parity of 1 (range 0–2) were recruited. Medical treatment failed in all cases and all women underwent laparoscopic surgery. Baseline clinical characteristics and surgical findings of these patients are reported in Table 1. None of the women had a history of a previous surgery for endometriosis. There was no case of an adenomyotic nodule of the anterior wall of the uterus in continuity with the bladder lesion.
During
Conclusion
Bladder endometriosis is a rare pathological entity, but diagnosis should be considered in all women complaining of catamenial bladder symptoms with negative urine cultures [6]. This possibility should also be considered in post-menopausal patients receiving HRT who report voiding symptoms and who are unsuccessfully treated for interstitial cystitis [2]. No large-scale studies have been conducted to compare medical to surgical therapy in bladder endometriosis lesions because of the rarity of
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Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review
2022, Journal of Minimally Invasive GynecologyCitation Excerpt :Seven authors did not report the suture thread used [1,3,14,18,26,30,31]. Regarding the technique to close the bladder defect, 14 studies had performed a suture in 2 layers [10,15,26,29,34,36] and specified the continuous suture [7,17,19,22,23,25,28,35]. Eight studies closed the bladder in one layer suture [15,16,20–22,24,31,33,34].
Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines
2018, Gynecologie Obstetrique Fertilite et SenologiePartial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy
2016, Gynecologie Obstetrique et FertiliteFull-thickness endometriosis of the bladder: Report of 31 cases
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyComplete loss of unilateral renal function secondary to endometriosis: A report of three cases
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