Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions.
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 follow-up 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 = 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.
Department of Gynecology, Obstetrics II and Reproductive Medicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier Universitaire Cochin, Saint Vincent de Paul, Pavillon Lelong, 82 avenue Denfert Rochereau, 75014 Paris, France. charles.chapron@cch.aphp.fr
Charles
C
Chapron
Antoine
A
Bourret
Nicolas
N
Chopin
Bertrand
B
Dousset
Mahaut
M
Leconte
Delphine
D
Amsellem-Ouazana
Dominique
D
de Ziegler
Bruno
B
Borghese
D000328:Adult; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D004715:Endometriosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult