Bladder endometriosis is the presence of endometrial-like tissue inside or on the surface of the bladder. It is usually a complication of deeply infiltrating pelvic endometriosis but may rarely develop on its own.
Urinary tract endometriosis occurs in around 1-5% of patients with endometriosis but this number increases to 19-53% in those with deep infiltrating endometriosis. Bladder involvement comprises around 70-85% of urinary tract endometriosis cases.
Symptoms:
- Frequent or urgent need to urinate
- Pain or burning during urination
- Pelvic pain especially when your bladder is full
- Lower back pain
- Blood in urine
Diagnosis:
If you’re experiencing the any or all of the above symptoms, your gynecologist might need to work you up for bladder endometriosis.
You will first get a pelvic exam and a pelvic ultrasound.
Your doctor may then ask for further imaging such as a pelvic CT or MRI.
A diagnosis can be made by visualizing the lesions with a scope inserted through your urethra into the bladder, a procedure termed cystoscopy, or by laparoscopic visualization of endometriosis involving the bladder.
Treatment:
To treat bladder endometriosis, surgical excision of the lesions is the optimal treatment to improve the symptoms.
Medical treatments are usually symptomatic treatments and will not eradicate or cure the lesions. Medical therapies include hormones such as combined oral contraceptives, gonadotropin releasing hormone agonists or aromatase inhibitors.
Surgery is the optimal management for bladder endometriosis, in which your doctor will remove all the endometriosis tissue growing around the bladder which will relief your symptoms. Surgery may be a combination of laparoscopy and cystoscopy, and could include shaving of the lesions from the bladder or excising part of the bladder ( partial cystectomy).
A transurethral resection (via cystoscopy) is minimally invasive and has a fast recovery time but may lead to incomplete lesion removal and persistence of symptoms. It is not strongly supported by evidence for treatment of bladder endometriosis.
A partial cystectomy, if done by a minimally invasive approach such as laparoscopy or robot, would also provide fast recovery. This procedure provides complete removal of the lesions and allows for treatment of other concomitant pelvic endometriosis. A partial cystectomy also has lower chances of recurrence, providing longer term relief.
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. Bladder endometriosis excision surgery is technically challenging and requires sometimes a multidisciplinary approach with a urologist.
Choose your surgeon with the training and the experience to manage these complex conditions.
Dr. Moawad is a highly reputable leading expert in this domain.
