Pathophysiology and management of urinary tract endometriosis

Abstract

Endometriosis predominantly affects the pelvic reproductive organs but can also affect the urinary tract. A number of theories for the pathogenesis of endometriosis have been suggested, but the exact mechanisms remain elusive. Endometriotic lesions can be found on both the ureter and bladder, and the optimal therapeutic approach depends on the extent, depth, and location of these lesions. Medical approaches, including hormonal therapies such as GnRH agonists and oral contraceptives, tend to be a temporary measure, but can be useful in a preoperative setting or if the patient is unsuitable for surgery, and are also useful as a postoperative treatment. If surgical resection is deemed appropriate, laparoscopic management with or without robotic assistance of urological endometriosis is feasible and advisable. Newer techniques, such as nerve-sparing surgery, might help to decrease the risk of urinary complications following resection of deeply infiltrating endometriosis.

Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis

“…Although medical treatment is offered with the aim of relieving symptoms, it is not definitely curative since pain symptoms recur at discontinuation of treatment [ 56 ]. Noteworthy, medication can be given pre- or/and postoperatively or if the patient is unsuitable for surgery [ 57 ]. The aim of postoperative medical treatment is symptoms relief and probable reduction of recurrences on the grounds of the hypothesis that “adjuvant” hormonal therapy against microscopic lesions may act like chemotherapy for malignancies; nonetheless, available clinical evidence denies this approach which actually is not surprising taking under consideration that hormonal therapy causes temporary suppression of endometriotic cells' action in contradiction to chemotherapic agents which destroy cancer cells of micrometastases [ 56 , 58 ].…”

“…GnRH analogues, danazol, progestins, and estrogen/progestin combination all have had some success in symptomatic relief; however, their use is limited in urinary tract endometriosis especially when there is extensive pelvic disease [ 96 , 103 , 115 , 117 ]. Therefore, medical hormone suppression should be considered as an adjuvant therapy to surgery and as preventive therapy for relapses when total hysterectomy with bilateral adnexectomy is not performed or when residual disease is left following surgery [ 55 – 57 ].…”

Outcome of sonography‐based minimally invasive surgery for deep infiltrating endometriosis of the ureter and urinary bladder – a retrospective cohort study

“…the urinary bladder and/or ureters, is affected, often causing ureteric obstruction and secondary hydronephrosis . Within this group, bladder endometriosis (BE) appears to occur more frequently than ureteral endometriosis (UE) or hydronephrosis . Symptoms related to BE often include urinary frequency, urgency, bladder pain, dysuria and hematuria, but these are not necessarily present in all patients with bladder disease .…”

Effect of Mst1 on Endometriosis Apoptosis and Migration: Role of Drp1-Related Mitochondrial Fission and Parkin-Required Mitophagy

“…It is an inflammatory and estrogen-dependent disease that affects 6-10% of women during their reproductive years and up to 50% of women receiving fertility treatments [1,2]. The endometrium is comprised of stromal cells and epithelial compartments.…”