Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Abstract

background: Deep infiltrating endometriosis (DIE) is presented as a disease with high recurrence risk. Bladder DIE is the most frequent location in cases of urinary endometriosis. Surgical removal has been recommended for bladder DIE but long-term outcomes remains unevaluated. The objectives of this study are to evaluate the rate of recurrence after partial cystectomy for patients presenting with bladder DIE and to outline the surgical modalities for handling associated posterior DIE nodules.methods: Seventy-five consecutive patients with histologically proved bladder DIE were enrolled at a single tertiary academic center between June 1992 and December 2007. A partial cystectomy was performed for each patient. Complete surgical exeresis of all associated symptomatic DIE lesions was carried out during the same surgical procedure. Bladder DIE patients were classified into three groups: patients with isolated bladder DIE (Group A); patients with associated symptomatic posterior DIE (Group B); patients with associated asymptomatic posterior DIE (Group C). Bladder DIE recurrence was defined as a clinical reappearance of the disease or radiological evidence that mandated a new surgical procedure. We assessed pelvic pain symptoms pre-and post-operatively using a 10-cm visual analogue scale.results: In a series of 627 patients with DIE, we observed 75 patients (12%) with bladder DIE. With a 50.9 + 44.6 months mean followup after partial cystectomy no patient presented evidence of bladder DIE recurrence. Post-operatively, we observed a significant improvement with respect to pain symptoms, with only two patients (2.7%) developing major complications during follow-up. Among patients with non-operated associated asymptomatic posterior DIE lesions (n ¼ 15), a second surgical procedure indicated for pain symptoms was necessary in only one patient (6.7%).conclusions: For patients presenting with bladder DIE, no patients required further surgery for bladder recurrence after radical surgery consisting in partial cystectomy. Exeresis of associated posterior DIE nodules is indicated only when they are symptomatic.

Diagnosis and Treatment of Bladder Endometriosis: State of the Art

“…In this case, the vesical nodule does not represent only one site of a moregeneralized disease, but it is usually isolated and may be caused by intraoperative dissemination of endometrial cells or by a suboptimal surgical technique for closure of the low transverse uterine incision [7,10,18,19,25,28,29,30,31]. …”

Questioning patients about their adolescent history can identify markers associated with deep infiltrating endometriosis

“…Histologically proven endometriotic lesions were classified in three groups: SUP, OMA, and DIE. The DIE was histologically defined when the muscularis (bladder, intestine, ureter) is involved by endometriotic lesions (24). Because these three types of endometriotic lesions are frequently concomitant (25,26), patients with endometriosis were arbitrarily classified as per the worst findings.…”

The mTOR/AKT Inhibitor Temsirolimus Prevents Deep Infiltrating Endometriosis in Mice

“…18 Low rectal endometriosis was defined preoperatively, based on the following clinical and endoscopic ultrasonographic criteria: rectal invasion of the infraperitoneal rectum (located within 8 cm of the dentate line, reachable on rectal examination) and full-thickness invasion of the muscular layer (Ͼ15 mm on rectal endoscopic ultrasonography). 7 DIE was confirmed in all cases by a pathologist experienced in endometriosis (S.A.).…”