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Fleischer K, Bachi A, Kam J, Narayanan P, Nair R, Khazali S. Bladder Endometriosis: What do we know and what is left to find out? A narrative review. Best Pract Res Clin Obstet Gynaecol 2024; 96:102536. [PMID: 39112342 DOI: 10.1016/j.bpobgyn.2024.102536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 09/10/2024]
Abstract
Bladder endometriosis accounts for 70-85% of urinary tract endometriosis cases. Urinary tract endometriosis occurs in approximately 1% of those living with endometriosis. Underlying aetiology and pathogenesis are not fully understood, but there are several plausible theories. As well as the typical pain symptoms, those with bladder endometriosis can experience several urinary tract symptoms. The manifestation of these symptoms can have complex pathways and processes. Imaging is accurate in the diagnosis of bladder endometriosis and clinicians should be mindful of the risk of silent kidney loss. Management should be guided by symptoms; both medical and surgical options are feasible. Surgical management offers potentially definitive treatment. Excisional surgery via bladder shave or partial cystectomy offers good improvement in symptoms with relatively low rates of serious complications and recurrence.
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Affiliation(s)
- Kyle Fleischer
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Faculty of Health and Medical Sciences, University of Surrey, Stag Hill, University Campus, Guildford, Surrey, England, GU2 7XH, UK.
| | - Averyl Bachi
- East Surrey Hospital, Surrey and Sussex NHS Foundation Trust, Canada Avenue, Redhill, Surrey, England, RH1 5RH, UK
| | - Jonathan Kam
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, England, SE1 9RT, UK
| | - Priya Narayanan
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, England, NW1 2PG, UK
| | - Rajesh Nair
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, England, SE1 9RT, UK
| | - Shaheen Khazali
- Centre for Endometriosis and Minimally Invasive Gynaecology CEMIG London, HCA the Lister Hospital, Chelsea Bridge Road, London, England, SW1W 8RH, UK; Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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Trigui M, Ouanes Y, Chaker K, Zehani A, Chelly I, Nouira Y. Bladder endometriosis: A serious disease. Urol Case Rep 2023; 48:102400. [PMID: 37123512 PMCID: PMC10133648 DOI: 10.1016/j.eucr.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Urinary tract endometriosis (UTE) is a very rare but serious form of infiltrating endometriosis because of the risk of urinary tract obstruction and loss of renal function. We report the case of A 42-year-old female patient admitted for intense right back pain with lower urinary tract disorders. An abdomino-pelvic ultrasound was done showing right uretero-hydronephrosis. Ureteroscopy showed an inflammatory-like stenosis of the right pelvic ureter. Given the young age of the patient, the poor quality of the right kidney, we opted for a right total nephro ureterectomy. The anatomopathological examination showed a bladder endometriosis .
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Affiliation(s)
- Mohamed Trigui
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
- Corresponding author. La Rabta Hospital, Department of Urology, Bab Saadoun, 1006, Tunis, Tunisia.
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Kays Chaker
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Alia Zehani
- Department of Pathology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Chelly
- Department of Pathology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
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Nagashima N, Hirata T, Arakawa T, Neriishi K, Sun H, Harada M, Hirota Y, Koga K, Wada-Hiraike O, Osuga Y. Long-term conservative management of symptomatic bladder endometriosis: A case series of 17 patients. Taiwan J Obstet Gynecol 2022; 61:606-611. [PMID: 35779908 DOI: 10.1016/j.tjog.2022.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the course of long-term conservative management of bladder endometriosis (BE). MATERIALS AND METHODS We retrospectively reviewed 17 cases of BE conservatively managed without surgery in our facility. The following factors were analyzed: age, medical history, lesion size, symptoms, hormonal treatment, and follow-up outcomes. RESULTS In this study, 15 patients received hormonal therapy and 2 did not. Oral contraceptive (OC), dienogest (DNG), and gonadotropin-releasing hormone agonist (GnRHa) were administered as the first regimen in 7, 5, and 3 patients, respectively. Of the 7 patients, OC administration was effective in alleviating urinary symptoms in all but 2 patients. Of 3 patients who received GnRHa, 2 switched to OC and then DNG, and 1 patient discontinued the treatment because of adverse effects. Of 5 patients who received DNG, all experienced symptom relief. DNG, OC, and GnRHa administration were effective and tolerable in 9 of 10 patients (90.0%), in 5 of 9 patients (55.6%), and in 2 of 3 patients (66.7%), respectively. In particular, 3 patients completed DNG treatment until menopause. The size of the BE lesion significantly decreased after 3 months of DNG administration, and the reduction effect was maintained until 48 months thereafter. CONCLUSION This study proposed that hormonal therapy for BE is an effective option for those who are not planning to conceive or to undergo surgery. Specifically, DNG may be suitable for patients refusing surgery, considering the effectiveness and tolerance for long-term use.
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Affiliation(s)
- Natsuki Nagashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan; Department of Obstetrics and Gynecology, Doai Kinen Hospital, Japan.
| | - Tomoko Arakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Kazuaki Neriishi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Hui Sun
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan
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Hirata T, Koga K, Taniguchi F, Takazawa N, Honda R, Tanaka T, Kurihara M, Nakajima J, Yoshimura K, Kitade M, Narahara H, Kitawaki J, Harada T, Katabuchi H, Horie S, Osuga Y. National survey of bladder endometriosis cases in Japan. J Obstet Gynaecol Res 2021; 47:1451-1461. [PMID: 33398892 DOI: 10.1111/jog.14656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 01/08/2023]
Abstract
AIM We aimed to describe the clinical presentation, operative or medical management, and postoperative recurrence of bladder endometriosis (BE). METHODS We conducted a national survey to investigate BE cases from 2006 to 2016 in Japan. Histologically diagnosed cases were extracted and then investigated for the following factors: age at diagnosis, body mass index, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow-up period, and postoperative recurrence. RESULTS Eighty-nine patients with pathologically benign BE were identified. Eighty patients underwent surgery, whereas nine did not. Moreover, 34 and 44 patients underwent transurethral resection (TUR) and partial cystectomy (PC), respectively. Cumulative recurrence rates were significantly higher with TUR than with PC (p < 0.05). The recurrence rate tended to be higher after laparoscopic PC (n = 24) than after open PC (n = 20), but the difference was not statistically significant (p = 0.0879). Of the nine nonsurgical patients, eight received hormonal therapy and one did not. Efficacy rates of dienogest, GnRH agonist, and OC were 85.7%, 66.7%, and 66.7%, respectively. Of five patients with BE extending to the ureter or ureteral orifices, two underwent PC and ureteroneocystostomy and one underwent total nephroureterectomy due to renal function loss. CONCLUSION To our knowledge, this is the first study to compare the postoperative recurrence of BE after TUR and PC. We found that cumulative recurrence rate is significantly lower after PC than after TUR. BE extending to the ureter or ureteral orifices is a very challenging condition. Further studies are required for the optimal management of BE.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan.,Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Naoko Takazawa
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Ritsuo Honda
- Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo, Tokyo, Japan
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Oita University, Oita, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University, Kyoto, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
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Abdalla Ribeiro HS, da Costa Porto BT, Bassoi L, Ninomiya GY, Tomasi MC, Cervantes GV, Ribeiro PA. Effect of nodule size on symptoms and the choice of surgical technique in patients with bladder endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520977996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: In this study, we evaluated the relationships between symptoms of bladder endometriosis (EDT), lesion size, and the subsequent surgical technique used to excise the lesion. Methods: This is retrospective observational study of patients who underwent surgery in the Gynecological Endoscopy and Endometriosis Section at Hospital da Santa Casa of São Paulo, Brazil. A sample population of 39 women diagnosed with bladder EDT was included from 463 women presenting with deep pelvic EDT between January 2010 and March 2017. Clinical evaluations and surgical treatments for each EDT were performed. Results: Of the 39 women, 43.58% had dysmenorrhea or dyspareunia and 2.56% had hematuria. Furthermore, 21.10% presented with dysuria and endometriotic nodules on the bladder ( p < 0.04). The nodules had reached the muscle layer in 97.30% of patients, and a further 2.60% had reached the mucosal layer. In addition to bladder involvement, other pelvic regions were affected, including the left (15.8%) and right (13.2%) round ligament, left (68.4%) and right (65.8%) uterosacral ligament, retrocervical region (84.20%), and ureter (45.71%). Conclusion: The patients’ pain symptoms were found to be associated with bladder endometriosis and nodule size. Partial cystectomy with complete lesion excision might be an effective treatment option to relieve these symptoms. A study with a larger sample population is needed to confirm these findings.
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Affiliation(s)
- Helizabet Salomão Abdalla Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Beatriz Taliberti da Costa Porto
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Luisa Bassoi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Mariana C Tomasi
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Graziele V Cervantes
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo, São Paulo, Brazil
| | - Paulo Ayroza Ribeiro
- Gynecology and Obstetrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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Alsinan TA, AlDahleh LA, Alreefi HAA, Albiabi SA, Alsouss YO, Alshayeb FA, Alshurafa ZH, Moukhtar Hammad AA, Altaweel WM. Endometriosis of the Urinary Bladder Causing a Right Hydronephrosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1360-1363. [PMID: 31519867 PMCID: PMC6761704 DOI: 10.12659/ajcr.917445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endometriosis is a chronic and benign condition in which endometrial glands and stroma are present outside the uterine cavity. The pathogenesis of endometriosis is not fully understood; however, several mechanisms have been hypothesized. Endometriosis is a common clinical presentation in gynecology, but affecting the urinary tract is a rare phenomenon, occurring in 0.3-12% of cases. In more severe forms, the initial presentation may be hydronephrosis or infertility. CASE REPORT We describe the case of a 25-year-old Saudi woman who presented with obstructive urinary tract symptoms and was diagnosed with urinary bladder endometriosis complicated with a right hydronephrosis. After thorough investigations and workups, the management was taken on by a multidisciplinary team approach. CONCLUSIONS This case report shows that hormonal therapy management resulted in a satisfactory outcome contrary to the surgical resection approach that is discussed in many articles.
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Affiliation(s)
| | | | | | | | - Yara O. Alsouss
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Alaa A. Moukhtar Hammad
- Department of Urologic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed M. Altaweel
- Department of Urologic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 2017; 108:913-930. [DOI: 10.1016/j.fertnstert.2017.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
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Montironi R, Gasparrini S, Lopez-Beltran A, Cheng L, Massari F, Montorsi F, Scarpelli M. Re: Umberto Leone Roberti Maggiore, Simone Ferrero, Massimo Candiani, et al. Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol 2017;71:790-807. Eur Urol 2017; 72:e139-e141. [PMID: 28576502 DOI: 10.1016/j.eururo.2017.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
| | - Silvia Gasparrini
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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