Standard Approach to Urinary Bladder Endometriosis.

Area of Science:

• Gynecologic Surgery
• Urologic Oncology
• Minimally Invasive Procedures

Background:

• Urinary endometriosis, affecting 1% of endometriosis cases, most commonly involves the bladder.
• Laparoscopic excision of bladder endometriosis is effective for symptom relief and has a low recurrence rate, but lacks a standardized technique.
• Partial cystectomy is a viable option for complete disease removal with low complication rates.

Observation:

• A case of a 31-year-old woman with a large, 3 cm bladder trigone endometriosis nodule presenting with dysuria and hematuria.
• A stepwise laparoscopic approach was employed for complete nodule excision, including pre-operative ureteral stenting.
• The procedure involved careful dissection, intentional bladder opening for complete visualization, and a two-step suturing technique.

Findings:

• Successful laparoscopic complete excision of a large bladder endometriosis nodule.
• The patient was discharged on postoperative day 2 with a catheter and double J stent, with no leakage confirmed by cystogram.
• One-year follow-up showed no recurrence, symptom resolution, and spontaneous pregnancy, indicating a favorable long-term outcome.

Implications:

• Demonstrates the feasibility and effectiveness of a standardized laparoscopic approach for large bladder endometriosis.
• Minimally invasive surgery can achieve complete disease removal, reducing the risk of lower urinary tract symptoms.
• This technique offers a safe and effective treatment option for bladder endometriosis, potentially improving fertility outcomes.