title: Combined transurethral approach with Versapoint(®) and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up.
abstract: BACKGROUND
  When endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1-2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint(®) and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up.
  
  
  METHODS
  We performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint(®)). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o'clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE(®). The bladder hole was repaired with a continuous 3-0 monofilament two-layer suture.
  
  
  RESULTS
  Operating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up.
  
  
  CONCLUSIONS
  A combined transurethral approach with Versapoint(®) and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.
authors.affiliation: Department of Gynecological Sciences and Human Reproduction, University of Padova, Via Giustiniani 3, 35128 Padua, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Giulia
authors.initials: G
authors.lastname: D'Agostino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
authors.forename: Luca
authors.initials: L
authors.lastname: De Zorzi
authors.forename: Massimo Dal
authors.initials: MD
authors.lastname: Bianco
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004598:Electrosurgery; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014521:Urethra; D001745:Urinary Bladder Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods