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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.