Bladder Endometriosis: Current Knowledge and Future Directions

Sep 19, 2024

Bladder Endometriosis: Unraveling Insights

Key Points

Importance:

Recognizing bladder symptoms early is vital for diagnosing bladder endometriosis, as delays can profoundly affect overall well-being.
Clinicians need to recognize the range of differential diagnoses that may overlap and contribute to the symptoms of bladder endometriosis.

Highlights:

Complete surgical excision is an effective management strategy for bladder endometriosis, providing symptom relief and a low recurrence rate.

What's done here:

This article by Fleischer et al. from the UK provides a comprehensive overview of bladder endometriosis in lecture format.
The authors cover its prevalence, etiology, symptoms, diagnosis, management, and surgical approaches in a systematic manner.

Basic Outlines:

Urinary tract endometriosis affects 1-12% of individuals with endometriosis, with bladder endometriosis being the most common, comprising 75-80% of cases.
Bladder endometriosis can develop as a primary condition or as a secondary result of pelvic surgery.
Key clinical symptoms include painful bladder filling, urgency, frequency, incontinence, voiding dysfunction, dysuria, and hematuria.
Suspected patients should undergo midstream urine dipstick testing, with or without microscopy, culture, and sensitivity, for differential diagnosis.
Ultrasound and MRI are effective tools for diagnosing bladder endometriosis, while retrograde pyelography and cystoscopy are used in select cases.
Individuals with risk factors for bladder cancer should be evaluated with a diagnostic cystoscopy.
Management options include conservative approaches, medical treatment, and surgical therapies.
In surgical management—whether via bladder shaving or partial cystectomy—the goal should be complete excision of the disease while preserving healthy tissue. Transurethral resection is not recommended.

Lay Summary

About 70-80% of urinary tract endometriosis occurs in the bladder, particularly affecting the base and dome regions. Endometriotic lesions can penetrate the detrusor muscle either partially or completely. Endometriosis affecting the uterovesical fold peritoneum or deep endometriosis that does not involve the bladder muscle, is not classified as "bladder endometriosis."

Patients with bladder endometriosis may experience symptoms such as suprapubic pain, urgency, dysuria, frequency, and hematuria. These symptoms can arise spontaneously or as a result of bladder injuries, such as those sustained during a cesarean section or hysterectomy. Bladder endometriosis is classified as primary based on its origin, and several theories explain its pathophysiology. For instance, lesions on the dome are believed to be associated with implants in the anterior cul-de-sac, while trigonal lesions may be related to changes in remnants of the Müllerian tract. Clinicians must consider various differential diagnoses for bladder endometriosis symptoms, and ındividuals at risk for bladder cancer should undergo a diagnostic cystoscopy. Investigations should include a comprehensive radiological assessment of the urinary tract and screening for obstructive uropathy.

Management should be symptom-based, utilizing medical, surgical, or combined treatments for relief. Surgical intervention should be prioritized for patients with endometriosis causing obstructive uropathy that could lead to kidney loss. Increasing awareness among allied specialties will improve assessment and management of bladder endometriosis. Multidisciplinary care within an endometriosis team is recommended for complex cases.

This comprehensive and well-written review by Fleisher et al. from the Center for Endometriosis and Minimally Invasive Gynecology at Lister Hospital in London, UK, provides an in-depth exploration of bladder endometriosis. It was recently published in Best Practice & Research: Clinical Obstetrics and Gynecology.