Bladder endometriosis in a patient with undirected manifestations: a case report

Endometriosis is defined as the presence of functional glands and stroma of the uterus outside its cavity. It affects 10-20% of women of reproductive age. It can form in different parts of the body; the involvement of the urinary tract is rare (1% of all cases).

We report here a case of a 37-year-old Syrian woman who presented to the clinic with urinary hesitancy, dysuria, suprapubic pain, and intermittent hematuria for a year. The patient experienced dysmenorrhea, irregular menstruation, dyspareunia, and pelvic pain for 3 years until now. According to the patient, these symptoms did not follow a specific pattern related to menstruation. The laboratory findings included hematuria and an international normalized ratio of 2.5. The radiological investigations revealed a 3 cm mass on the posterior bladder wall extending toward the uterus. The surgical procedure was conducted through a lower abdominal approach employing a Pfannenstiel incision. Upon gaining access to the pelvic cavity, the bladder was carefully exposed and opened. Examination revealed a solid mass located on the posterior bladder wall, which was meticulously dissected and excised to ensure the preservation of adjacent anatomical structures. The bladder was subsequently repaired without complications. The postoperative period was uneventful, and the patient was discharged without any immediate complications. Histopathological analysis of the excised lesion confirmed a diagnosis of benign bladder endometriosis. The patient underwent regular postoperative surveillance for 2 years, during which no evidence of recurrence was observed.

The case highlights the importance of considering bladder endometriosis in the differential diagnosis of patients presenting with unexplained urinary symptoms and pelvic pain. Early recognition and surgical management can lead to favorable outcomes.