Urological Challenges in Endometriosis Surgery - Guenter Noe, MD

Endometriosis can affect the urinary tract and when this happens surgical treatment is necessary.

Key Points

Information about the presenter: This presentation is by Dr. Guenter K. Noé M.D., Ph.D., Head of Department of Rheilandklinikum Dormagen, which is one of the biggest certified endometriosis centers in Germany. Dr. Noé is Vice President of the International Society of Gynecological Endoscopy. Dr. Noé’s presentation is titled “Urological Challenges in Endometriosis Surgery”.

Highlights:

• Around 0.3-12% of endometriosis cases have urological involvement, especially in advanced stages.
• Clinicians experienced in magnetic resonance imaging and ultrasound play a key role in the diagnosis of urinary involvement.
• There is no medical treatment available for deep infiltrating endometriosis and most lesions are treated with surgery.

Importance: 

• Surgery is recommended even if the symptoms are not very severe because if the ureter is blocked by an endometriotic lesion, this could potentially lead to the loss of the kidney. Similarly, bladder endometriosis may lead to tissue loss if treated too late.

Remarks:

• When there is urological involvement, endometriosis affects the kidneys in 4% of cases, the ureter in 15% of cases, the bladder in 80-84% of cases, and the urethra in 2% of cases.
• 80% of cases are extrinsic while 20% of cases have mucosal or submucosal involvement.
• Diagnosis is done through physical examination, a transvaginal ultrasound, magnetic resonance imaging, and cystoscopy (or bladder scope).
• The symptoms of ureter involvement are mostly caused by inflammation and the involvement of local nerves and include urgency, stress urinary incontinence (when urine leaks out with sudden pressure on the bladder and urethra), nocturia, voiding dysfunction, and urinary retention.
• The symptoms of bladder endometriosis include difficult urination, bladder pain, and blood in the urine. 
• There is no medical treatment available for deep infiltrating endometriosis and surgery is the only option.
• Nerve and tissue sparing surgery should be performed in specialized centers by a multidisciplinary team comprising gynecological surgeons and urologists.

Lay Summary

In this presentation, Dr. Guenter Noé, Head of Department of Rheilandklinikum Dormagen in Germany talks about endometriosis affecting the urinary tract. Dr. Noé starts by describing the different parts of the urinary tract that can be affected by endometriosis including the kidneys, ureter, bladder, and urethra. 

Dr. Noé then talks about the approaches that can be used to diagnose urinary endometriosis including physical examination, a transvaginal ultrasound, magnetic resonance imaging, and cystectomy. He stresses the importance of having clinicians specializing in the field of MRI and ultrasound for better diagnosis.

He then moves onto the symptoms of endometriosis of the ureter and bladder and shows a number of surgery videos of lesion removal and ureter and bladder repair. 

Dr. Noé concludes his presentation by stressing the importance of surgical treatment even if a patient’s symptoms are not very severe, and the need to adopt a multidisciplinary approach in a specialized center. 

Research Source: https://www.endofound.org/urological-challenges-in-endometriosis-surgery-guenter-noe-md?pop=mc