Bladder Endometriosis: Diagnostic, Therapy, and Outcome of a Single-Center Experience

Abstract

Background/Objectives: Endometriosis is a benign condition affecting up to 10% of women at reproductive age. The urinary tract is affected in 0.3-12.0% of women with endometriosis and in 19.0-53.0% of women with deep infiltrating endometriosis. The bladder is the most commonly affected organ in the urinary tract. Bladder endometriosis is defined by the presence of endometriosis lesions in the detrusor muscle, with partial or complete thickness involvement. Methods: This was a retrospective study. The study analyzed surgical reports of 11,714 patients who underwent endometriosis laparoscopy, and included only 42 patients with bladder endometriosis. Results: We found that 0.35% of patients with endometriosis had bladder endometriosis. In total, 29 patients underwent phone follow-up. In total, 26 patients (90%) reported a general improvement in their symptoms (e.g., improving the dysmenorrhea, lower abdominal pain), with a 100% improvement in their dysuria. Only two patients (7%) reported no change in symptoms (dysmenorrhea and dyspareunia). Conclusions: Gynecologists can perform laparoscopic surgical treatment of bladder endometriosis in most cases. If ureteroneocystostomy is required or the localization of the endometriosis nodule is unfavorable, an intervention by an interdisciplinary team is recommended. Both laparoscopic partial bladder resection and shaving can be considered effective methods with low complication risk. This surgical approach requires excellent laparoscopic skills.

Keywords: DIE; bladder endometriosis; bladder shaving; dysuria; hematuria; laparoscopy; partial bladder resection.

Figure 1

Transvaginal sonography. (A) The endometriosis nodule is located on the bladder dome and the bladder base. (B) The endometriosis nodule is located on the bladder dome, far from the bladder base. (C) The endometriosis nodule is located on the bladder dome, close to the bladder base.

Figure 2

Cystoscopy. (A) Mucosa is infiltrated. (B) Protrusion of mucosa by the endometriosis nodule, without infiltration.

Figure 3

Laparoscopic evaluation. (A) Bladder endometriosis lesion and adhesion between the uterus and the bladder. (B) Adenomyosis and bladder endometriosis. (C) Lateral bladder nodule, right wall endometriosis. Bladder dome is unaltered.

Figure 4

Laparoscopic partial bladder resection. (A) Partial bladder resection. (B) Shaving. The bladder mucosa is merely opened but not resected.

Figure 5

Visualization of the ureters. (A) Detection of the ureter and ureter orifice. (B) Ureters and D-J stents.

Figure 6

Suture. (A) Laparoscopic suture of the bladder after the bladder part resection. (B) Six months after the partial bladder resection.

Figure 7

Number of patients relating to rASRM and ENZIAN classification. rASRM—Revised American Society of Reproductive Medicine, classification of endometriosis; ENZIAN, classification of deep infiltrating endometriosis. P—peritoneal endometriosis, O—ovarian endometriosis, T—Adnexal adhesions, A—vagina, rectovaginal space, B—uterosacral ligaments/cardinal ligaments/pelvic sidewall, C—rectum endometriosis, FA—adenomyosis, FU—ureter endometriosis, FI—other intestinal locations (sigmoid colon, small bowel).