Diagnosis and treatment of bladder endometriosis: state of the art.
BACKGROUND
The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead to good results.


OBJECTIVE
To define the state of the art in the diagnosis and treatment of bladder endometriosis.


METHODS
We performed a literature review by searching the MEDLINE database for articles published between 1996 and 2011, limiting the searches to the words: urinary tract endometriosis, bladderendometriosis, symptoms, diagnosis and treatment.


RESULTS
Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. The diagnosis has to be considered as a step-by-step procedure. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone.


CONCLUSIONS
The bladder is the most common affected site in urinary tract endometriosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. The surgical urological treatment might lead to good results in terms of patients' compliance and prognosis.
Department of Urology, San Raffaele Scientific Institute, Milan, Italy. carmen.maccagnano@gmail.com
Carmen
C
Maccagnano
Federico
F
Pellucchi
Lorenzo
L
Rocchini
Massimo
M
Ghezzi
Vincenzo
V
Scattoni
Francesco
F
Montorsi
Patrizio
P
Rigatti
Renzo
R
Colombo
D015653:Cystectomy / Q000379:methods; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014572:Urology / Q000379:methods
D006728:Hormones