Identification and Resection of Bladder Endometriosis

Abstract

Study Objective

To demonstrate surgical management of bladder endometriosis.

Design

Surgical Video.

Setting

Academic medical center.

Patients or Participants

A 29-year-old female with a history of anxiety presenting with dysmenorrhea, bladder spasms, and deep and superficial dyspareunia. MRI showed a 2.5 cm hypointense focus between the inferior uterine body and superior aspect of the urinary bladder.

Interventions

On diagnostic laparoscopy, the patient was found to have deeply infiltrating endometriosis in the anterior cul-de-sac. On cystoscopy, a bulging mass concerning for endometriosis was visible in the bladder but did not invade the bladder mucosa. The patient was scheduled for a joint case with urology for resection of the bladder lesion. At the beginning of the case, repeat cystoscopy redemonstrated the mass and bilateral ureteral stents were placed. On robotic assisted laparoscopy, the mass was found to be densely adhered to the anterior aspect of the uterus and the vesicovaginal septum. Attempts were made to dissect the endometriotic nodule off the detrusor muscle but, due to the extent of muscle invasion, the decision was made to incise the bladder mucosa. An intentional cystotomy was made and carried out circumferentially to remove the entirety of the lesion. Cystotomy was repaired in two layers with 2-0 vicryl in running fashion. A leak test confirmed watertight closure.

Measurements and Main Results

Following resection of bladder lesion, patient reported complete resolution of her dysmenorrhea, bladder spasms, and dyspareunia. Cystogram two weeks later was negative for extravasation.

Conclusion

Bladder endometriosis is a common variant of deep infiltrating endometriosis. A partial cystectomy is a safe and effective treatment option.