Endometriosis and the Urinary Tract: From Diagnosis to Surgical Treatment

Abstract

We aim to describe the diagnosis and surgical management of urinary tract endometriosis (UTE). We detail current diagnostic tools, including advanced transvaginal ultrasound, magnetic resonance imaging, and surgical diagnostic tools such as cystourethroscopy. While discussing surgical treatment options, we emphasize the importance of an interdisciplinary team for complex cases that involve the urinary tract. While bladder deep endometriosis (DE) is more straightforward in its surgical treatment, ureteral DE requires a high level of surgical skill. Specialists should be aware of the important entity of UTE, due to the serious health implications for women. When UTE exists, it is important to work within an interdisciplinary radiological and surgical team.

Keywords: bladder; endometriosis; hydroureter; magnetic resonance imaging; ultrasound; ureter.

Figure 1

Schematic drawing illustrating the four bladder zones: trigone, bladder base, bladder dome, and extra-abdominal bladder. The demarcation point between the base and the dome of the bladder is the uterovesical pouch. Reprinted with permission from John Wiley and Sons.

Figure 2

Transvaginal ultrasound depiction of the bladder. (A) Normal bladder and (B–D) three bladder deep endometriosis nodules, identified with white arrows.

Figure 3

Bladder base deep endometriosis nodule encroaching on the bladder dome.

Figure 4

Transvaginal ultrasound depiction of ureteral deep endometriosis nodule (white arrow) and hydroureter (black arrow). The nodule originates from the uterosacral ligament but infiltrates the parametrium and extrinsically compresses the ureter.

Figure 5

Magnetic resonance imaging depiction of bladder deep endometriosis. Sagittal T2-weighted plane depicting deep endometriosis nodule in hyposignalT2, which is infiltrating the detrusor muscle of the bladder (white thin arrows).

Figure 6

Magnetic resonance imaging depiction of left ureteral deep endometriosis. (A) Axial T2-weighted plane depicting hyposignal nodule causing stenosis of the left ureter (white arrows), which appears dilated and is confirmed on the (B) magnetic resonance urography in the coronal HASTE T2 plane.

Figure 7

Laparoscopic depiction of bladder deep endometriosis (A) before and (B) during full-thickness resection.

Figure 8

Laparoscopic depiction of right ureteral deep endometriosis leading to hydroureter.

Figure 9

Laparoscopic depiction of a transected ureter (A) without stent and (B) with stent, followed by an (C) initial and (D) complete ureteroneocystostomy secondary to ureteral deep endometriosis.