Bladder Endometriosis: An Updated Narrative Review with Three Surgical Cases

Bladder endometriosis (BE) represents a rare yet clinically significant manifestation of deep infiltrating endometriosis. It is frequently underdiagnosed owing to nonspecific urinary symptoms and the coexistence of other urological or gynecological conditions. Management remains challenging, requiring a high index of clinical suspicion, advanced imaging, and multidisciplinary surgical expertise.

We conducted a comprehensive narrative review of the current evidence on the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of BE, supported by three representative cases that highlight diagnostic difficulties and surgical challenges.

The literature indicates that BE accounts for 70-85% of urinary tract endometriosis, and that cyclic hematuria occurs in fewer than half of patients. Magnetic resonance imaging is the gold standard for preoperative lesion mapping, and histopathology provides definitive diagnosis. Medical therapy offers temporary symptomatic relief but is limited by high recurrence rates. Partial cystectomy, preferably performed using minimally invasive approaches, remains the first-choice treatment for detrusor-infiltrating lesions. Our cases reflect the heterogeneity of presentation and demonstrate favorable outcomes with laparoscopic partial cystectomy with barbed suture closure.

Bladder endometriosis should be considered in the differential diagnosis of women of reproductive age presenting with chronic pelvic pain or lower urinary tract symptoms, particularly those with a history of pelvic surgery. Accurate diagnosis relies on the integration of clinical suspicion, imaging findings, and histopathological confirmation. Surgical excision remains the cornerstone of treatment of choice, with complete resection the primary therapeutic goal. Emerging surgical techniques, including the use of barbed sutures, show promise in reducing procedure-related morbidity. Further research is required to optimize diagnostic and therapeutic strategies.