Hormonal treatment for severe hydronephrosis caused by bladder endometriosis

Abstract

The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydronephrosis and bladder endometriosis was determined in the etiology. After the patient was pathologically diagnosed, Levonorgestrel-Releasing Intrauterine System (LNG-IUS) was administered to the uterine cavity. At the 12-month follow-up, endometriosis was not observed in the cystoscopy and symptoms had completely regressed. Hydronephrosis may be observed after exposure of the ureter, and silent renal function loss may develop in patients suffering from endometriosis with bladder involvement. For patients with moderate or severe hydronephrosis associated with bladder endometriosis, LNG-IUS application may be separately and successfully used after conservative surgery.

Figure 1

Urinary system ultrasonography showing a massive lesion of 3 × 4 cm extending into the bladder on the left side wall of the bladder.

Figure 2

Abdominal contrast Computed Tomography showing a massive lesion of 3 × 4 cm extending into the bladder on the left ureter orifice on the left side wall of the bladder.

Figure 3

The anterograde pyelography was taken through the nephrostomy catheter and the contrast material was not transmitted to the bladder in the ureterovesical junction.

Figure 4

(a) Photomicrograph showing the hemosiderin-laden macrophages in the bladder wall. (Haematoxylin and eosin staining, original magnification ×40.) (b) Photomicrograph showing the estrogen-containing epithelial cells in the bladder wall. (Immunohistochemical staining, original magnification ×40.)