Endometriosis of bladder: outcomes after laparoscopic surgery.
OBJECTIVE
To describe outcomes after laparoscopic excision of deep bladder endometriosis.


METHODS
Retrospective study (Canadian Task Force classification II-3).


METHODS
University hospitals.


METHODS
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.


METHODS
Laparoscopic excision of bladder endometriosis.


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.


CONCLUSIONS
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.
Kovoor
Elias
E
IRCAD (Research Institute Against Digestive Cancer) and University Hospitals Strasbourg (Hautepierre Hospital and CMCO [Centre Medico-Chirurgical et Obstetrical] Hospital), Strasbourg, France. kovoeli@gmail.com
Nassif
Joseph
J
Miranda-Mendoza
Ignacio
I
Wattiez
Arnaud
A
D000328:Adult; D015653:Cystectomy / Q000379:methods*; D004412:Dysmenorrhea / Q000209:etiology; D004414:Dyspareunia / Q000209:etiology; D053159:Dysuria / Q000209:etiology; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D017060:Patient Satisfaction; D011247:Pregnancy; D018873:Pregnancy Rate; D001745:Urinary Bladder Diseases / Q000601:surgery*