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Kaneko M, Fujihara A, Iwata T, Ramacciotti LS, Palmer SL, Oishi M, Aron M, Cacciamani GE, Duddalwar V, Horiguchi G, Teramukai S, Ukimura O, Gill IS, Abreu AL. A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI. Int Braz J Urol 2024; 50:319-334. [PMID: 37450770 PMCID: PMC11152327 DOI: 10.1590/s1677-5538.ibju.2024.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). MATERIALS AND METHODS We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC. RESULTS Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. CONCLUSIONS Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI.
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Affiliation(s)
- Masatomo Kaneko
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of UrologyKyotoJapanDepartment of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of UrologyKyotoJapanDepartment of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuyoshi Iwata
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of UrologyKyotoJapanDepartment of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Lorenzo Storino Ramacciotti
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Suzanne L. Palmer
- University of Southern CaliforniaKeck School of MedicineDepartment of RadiologyLos AngelesCaliforniaUSADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Masakatsu Oishi
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of UrologyKyotoJapanDepartment of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manju Aron
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineDepartment of PathologyLos AngelesCaliforniaUSADepartment of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Giovanni E. Cacciamani
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineDepartment of RadiologyLos AngelesCaliforniaUSADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Vinay Duddalwar
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineDepartment of RadiologyLos AngelesCaliforniaUSADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Go Horiguchi
- University HospitalThe Clinical and Translational Research CenterDivision of Data ScienceKyotoJapanDivision of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of BiostatisticsKyotoJapanDepartment of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Kyoto Prefectural University of MedicineGraduate School of Medical ScienceDepartment of UrologyKyotoJapanDepartment of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Inderbir S. Gill
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andre Luis Abreu
- University of Southern CaliforniaUSC Institute of Urology and Catherine & Joseph ArestyCenter for Image-Guided SurgeryLos AngelesCaliforniaUSAUSC Institute of Urology and Catherine & Joseph Aresty, Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern CaliforniaKeck School of MedicineDepartment of RadiologyLos AngelesCaliforniaUSADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Diniz ALL, Resende JAD, de Andrade CM, Brandão AC, Gasparoni MP, Favorito LA. Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review. Int Braz J Urol 2023; 49:564-579. [PMID: 37450770 PMCID: PMC10482465 DOI: 10.1590/s1677-5538.ibju.2023.9907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies. MATERIALS AND METHODS Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo's database using the following MeSH terms: ('endometriosis') AND ('urology' OR 'urological' OR 'urologist') AND ('bladder' OR'vesical') AND ('ureteral' OR 'ureter').Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings. RESULTS Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification. CONCLUSIONS DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques.
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Affiliation(s)
- André L. Lima Diniz
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - José Anacleto D. Resende
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Cláudio M. de Andrade
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Alice C. Brandão
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Mauro P. Gasparoni
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Pérez Vidal JR, Marín Sánchez MP, Moreno Alarcón C, Guijarro Campillo AR, Nieto Díaz A. A Combined Approach: Laparoscopic Partial Bladder Prior Transurethral Resection for Bladder Endometriosis-Case Report and Surgical Video Presentation. Urology 2023; 178:187-189. [PMID: 37230270 DOI: 10.1016/j.urology.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Bladder endometriosis is the presence of stroma and endometrial glands in the thickness of the detrusor muscle. The main symptoms it produces are dysuria and hematuria whose intensity is directly proportional to the size of the nodule. It is a difficult entity to diagnose for which physical examination is essential. Treatment can be medical, with hormonal therapies, or surgical by transurethral resection of the nodule and laparoscopic partial cystectomy. METHODS To show a clinical case and review the literature about the technique used. RESULTS A 29-year-old patient diagnosed with bladder endometriosis in which a combined approach was decided by laparoscopic partial cystectomy after transurethral resection: the patient came to our office for chronic pelvic pain, dysuria, dysmenorrhea, and a physical examination that showed a painful nodule on the anterior side of the vagina. A transvaginal ultrasound, magnetic resonance imaging, and cystoscopy confirm the diagnosis of bladder endometriosis. After a review of the literature on the management of this entity, the patient's clinic, and reproductive desires, the combined approach with excellent results was decided. Dysmenorrhea and dysuria disappeared, preserving the fertility of the patient who became pregnant 6 months after the intervention. CONCLUSION The use of the combined approach allows to reduce the limitations of both techniques separately.
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Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola ALD, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1294-1302. [PMID: 36252916 DOI: 10.1016/j.jmig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This systematic review aimed to review all the available evidence regarding bladder endometriosis (BE) surgical techniques, resolution of symptoms, and nodule size. DATA SOURCES We conducted systematic searches in PubMed MEDLINE, Embase, Latin American and Caribbean Centre on Health Sciences Information, Cochrane Library, and Web of Science databases from inception to December 2021. METHODS OF STUDY SELECTION Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search yielded 1279 articles. Two reviewers independently screened abstracts and reviewed full-text articles to meet the eligibility criteria: women diagnosed as having BE, treated surgically to remove the BE nodule, and reported of the nodule size and/or symptoms after the surgery. We included 28 studies, which mainly were case reports and case series. TABULATION, INTEGRATION, AND RESULTS The following information was extracted from the included studies: author, country, publication year, study design, number of patients, age, surgery performed, follow-up time, operation time, nodule location, nodule size, and postsurgical symptoms. Patients' ages range from 26 to 44 years and most women were nulliparous. The BE nodule size ranged from 0.7 to 5.5 cm, and the most frequent location (63.57%) was the posterior wall. Dysuria was reported by 27.18% of women and generic lower urinary tract symptoms were reported by 27.95%. After surgery, the recurrence rate of urinary symptoms was 7.34%. Most studies performed a partial cystectomy to remove the nodule, showing that the disease affects the bladder mucosa frequently. CONCLUSION Surgical treatment with complete excision of BE lesion was shown to improve complaints of urinary symptoms in patients with BE. Given that most of the studies evaluated were descriptive, additional studies with a large sample population and a better level of evidence for this condition are needed.
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Affiliation(s)
- Mariana Carpenedo Tomasi
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro).
| | - Paulo Augusto Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Daniela Farah
- Department of Gynecology, Health Technologies Assessment Center - Universidade Federal de São Paulo, Sao Paulo, Brazil (Drs. Farah)
| | - Graziele Vidoto Cervantes
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Ana Luiza De Nicola
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
| | - Helizabet Salomão Abdalla-Ribeiro
- Gynecological Endoscopy and Endometriosis Clinic, Faculdade de Ciências Médicas da Santa Casa de Misericordia de São Paulo (Drs.Tomasi, Ribeiro, Cervantes, Nicola, Abdalla-Ribeiro)
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Lertvikool S, Tingthanatikul Y, Hongsakorn W, Srisombut C, Nakpalat K, Weerakiet S. Outcomes of Laparoscopic Partial Cystectomy of Bladder Endometriosis: A Report of 18 Thai Women. WOMEN'S HEALTH REPORTS 2021; 2:369-374. [PMID: 34671756 PMCID: PMC8524725 DOI: 10.1089/whr.2021.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Aim: To determine the outcomes of laparoscopic partial cystectomy (LPC) for bladder endometriosis (BE). Methods: This was a retrospective study using medical records of women who underwent LPC for BE between January 2009 and December 2017. Demographic characteristics, surgical findings, including surgical site and size of the bladder lesion, endometriosis at other locations, and pre- and postoperative hormonal treatment data were collected. Results: We analyzed data of 18 women with full-thickness BE. The patients had a mean age of 34 (range, 26–45) years and body mass index of 21.6 (range, 16.1–25) kg/m2. All women had dysmenorrhea. Other symptoms noted include dysuria, gross hematuria, and infertility. BE with a mean diameter of 2.7 cm (range, 1–5) was most commonly found at the posterior wall of the bladder (94.4%). Peritoneal endometriosis (94.4%), endometrioma (33.3%), and deep endometriotic nodules (22.2%) in the posterior compartment were also found. No surgical complications were observed. Postoperative hormonal treatment was administered to 14 (77.8%) patients. All symptoms improved after the surgery. No recurrence was found after 30 (range, 12–74) months of follow-up. Conclusion: LPC is an effective treatment option for BE.
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Affiliation(s)
- Srithean Lertvikool
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Tingthanatikul
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woradej Hongsakorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Srisombut
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Katanyuta Nakpalat
- Women Health Centre, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhon Royal Academy, Bangkok, Thailand
| | - Sawaek Weerakiet
- Division of Obstetrics and Gynecology, Bangkok Hospital Udonthani, Udonthani, Thailand
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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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Shah P, Shah P, Patel PB, Parmar JS, Shah F. Bladder Endometriosis: Management by Cystoscopic and Laparoscopic Approaches. J Minim Invasive Gynecol 2019; 26:807-808. [DOI: 10.1016/j.jmig.2018.09.782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
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Case report and surgical video presentation: Combined laparoscopic and cystoscopic partial bladder cystectomy for excision of deeply infiltrating endometriosis. Ann Med Surg (Lond) 2018; 35:173-175. [PMID: 30319775 PMCID: PMC6180305 DOI: 10.1016/j.amsu.2018.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Whilst endometriosis is a relatively common condition, deeply infiltrating endometriosis (DIE) of the bladder is less so, and when medical treatment fails, surgical management is an effective option. We present a case report and surgical video of a patient undergoing combined laparoscopic and cystoscopic excision of deeply infiltrating endometriosis of the bladder. Design Case report (Canadian Task Force Classification III) and step-by-step explanation of the surgery using video. Exemption was granted from the local institutional review board. Presentation of case We present a case report and surgical video of a 36-year-old nulliparous patient presenting with a 12-month history of sudden onset cyclical dysuria and haematuria. Imaging demonstrated a deeply infiltrating endometriotic nodule involving the bladder. The patient underwent a combined laparoscopic and cystoscopic excision of deeply infiltrating endometriosis of the bladder. The procedure was uneventful and the patient progressed to a full recovery. Discussion DIE is a highly invasive form of endometriosis which is defined arbitrarily as endometriosis infiltrating beneath the peritoneum by 5mm or greater. When medical therapy is declined or fails, surgical excision by partial cystectomy would appear to be the most effective management option. A combination of cystoscopy and laparoscopy has been shown to be a safe and feasible procedure, with a low rate of complications. It represents the ideal way by which to identify the resection limits for complete excision of the lesion, and allows for optimal repair of the bladder defect. Conclusion Combined laparoscopic and cystoscopic partial cystectomy for excision of deeply infiltrating bladder endometriosis is a safe and feasible procedure in our institution. A case of surgical management of deeply infiltrating endometriosis of the bladder is reported. Combined cystoscopic and laparoscopic excision can be performed for the treatment of this form of endometriosis. This approach is safe, feasible and has a low rate of complications in the current literature.
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Affiliation(s)
- Srisupa Laopakorn
- Department of Obstetrics and Gynecology, Ramkhamhaeng Hospital, Bangkok, Thailand
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
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