Rare case of bladder endometriosis reported in NEJM

Dr Jiun-Hung Geng at Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan and colleagues, at Ospedali Riuniti Marche Nord, Pesaro, Italy have reported a rare case of Bladder Endometriosis. The case has appeared in the New England Journal of Medicine.

Bladder endometriosis is a rare form of the condition where tissue resembling the uterus lining grows in the urinary bladder causing severe discomfort. When it forms only on the surface of the bladder, it is called superficial endometriosis, and if it develops inside the bladder lining or wall, it is called deep endometriosis. A 2014 study reports that as few as 1 to 2 per cent of women with endometriosis may have endometrial growths in their urinary system, and the bladder is the organ most likely to be affected.

Segmental bladder resection/partial cystectomy is the bladder-preserving surgery and offers the complete removal of bladder endometriotic nodules. Laparoscopic/robotic excision increases the chances of complete removal of nodules but may lead to inadvertent removal of the excess bladder wall and increase the risk of complications, especially in cases of large lesions in close proximity to ureteric orifices. Thus, simultaneous laparoscopy and cystoscopy offer the most effective way of complete resection of bladder endometriotic nodules, relieving symptoms and minimizing intraoperative and postoperative complications and recurrence rates in patients.

A 38-year-old woman presented to the outpatient urology clinic with a 6-month history of intermittent gross hematuria, pain with urination, and pelvic pain. Her medical history was notable for a cesarean section 6 years earlier and a total abdominal hysterectomy for uterine myoma and adenomyosis 1 year earlier.

On physical examination, there was no abdominal or pelvic tenderness. Ultrasonography followed by abdominal and pelvic computed tomography revealed a hypervascular mass (5.3 cm by 4.3 cm by 4.2 cm) over the bladder dome (Panel A, arrow).

Cystoscopy showed edematous submucosal multiloculated lesions at the bladder dome (Panel B). The results of a biopsy of the lesion were nondiagnostic. Partial cystectomy was performed, and histopathological analysis confirmed the diagnosis of bladder endometriosis. Bladder endometriosis may be asymptomatic or associated with urinary urgency or frequency, dysuria, or cyclical gross hematuria. The woman had no recurrence at follow-up 1 year later.

For further reference log on to: DOI: 10.1056/NEJMicm1815447