Endometriosis of Bladder: Outcomes after Laparoscopic Surgery
Received 4 March 2010; accepted 19 May 2010. published online 26 July 2010.
Abstract
Study Objective
To describe outcomes after laparoscopic excision of deep bladder endometriosis.
Design
Retrospective study (Canadian Task Force classification II-3).
Setting
University hospitals.
Patients
Twenty-one consecutive patients with endometriotic nodule on the bladder (infiltrating detrusor muscle) from a series of 169 patients were included in the study. The primary outcome studied was resolution of bladder symptoms. Secondary outcomes included complication rates, recurrence rates, and pregnancy rates after laparoscopic surgery.
Interventions
Laparoscopic excision of bladder endometriosis.
Measurements and Main Results
Laparoscopy was feasible in all cases without the need for conversion. Median follow-up was 20 months. Ten patients (47.6%) underwent partial cystectomy, and the remaining patients underwent partial-thickness excision of the detrusor muscle. Sixteen patients (76%) had associated deep lesions in the pelvis. The most common associated lesions were rectovaginal nodules (38%) and ureteric lesions (14%), with signs of obstruction. Major complications developed in 3 patients (14%), primarily related to bowel resection. Six patients became pregnant (60%). No patients experienced disease recurrence.
Conclusion
Laparoscopic excision is feasible in all types of bladder endometriosis but often involves multiple procedures to manage associated lesions, especially rectovaginal nodules and ureteric lesions. Previous reports have suggested that ureteric lesions are not associated with bladder endometriosis; however, this was not true in our series. Complications are primarily related to severity of the disease and associated procedures. Partial cystectomy is not required in all cases to achieve adequate clearance. Complete excision of the disease is associated with resolution of bladder symptoms and low recurrence rates.
IRCAD (Research Institute Against Digestive Cancer) and University Hospitals Strasbourg (Hautepierre Hospital and CMCO [Centre Medico-Chirurgical et Obstetrical] Hospital), Strasbourg, France
Corresponding author: Elias Kovoor, MRCOG, IRCAD and University Hospitals Strasbourg (Hautepierre Hospital and CMCO Hospital), 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France.
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
ABSTRACT