A surgical case involving bladder endometriosis
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VIDEO ARTICLE
A surgical case involving bladder endometriosis Claudia Cheng & Martin Healey & Anita Clarke
Received: 24 July 2012 / Accepted: 5 November 2012 / Published online: 10 January 2013 # The International Urogynecological Association 2013
Abstract Introduction and hypothesis The purpose is to demonstrate a surgical case of severe endometriosis involving a bladder endometriotic nodule. Methods This patient has a large 4-cm endometriotic nodule which obliterates the uterovesical pouch and invades the bladder. A video recording was made of the surgery involving a combined laparoscopic and transurethral approach to excise the endometriotic nodule together with partial cystectomy of the bladder. The surgery was carried out by two gynaecological laparoscopic surgeons and a urologist. Results This video is a good demonstration of the multidisciplinary approach that is required for such a complex case. The surgery itself is technically difficult as the nodule is densely adherent to both bladder and uterus. This video was presented at the 2011 International Urogynecological Association 36th Annual Meeting in Portugal. Conclusions Endometriosis involving the urinary tract is rare and only occurs in approximately 1% of all patients with endometriosis (Schneider et al., Int J Urol 13:902–904, 2006). Surgery often involves a multidisciplinary approach and the surgery itself is technically challenging. This video is a good example of such a case.
This video was presented at the 2011 International Urogynecological Association 36th Annual Meeting in Portugal. Electronic supplementary material The online version of this article (doi:10.1007/s00192-012-1995-5) contains supplementary material, which is available to authorized users. C. Cheng (*) : M. Healey Royal Women’s Hospital, Suite 2, Level 2, 20 Flemington Road, Parkville, Melbourne, VIC 3052, Australia e-mail: [email protected] A. Clarke St Vincent’s Hospital, Melbourne, VIC, Australia
Keywords Bladder endometriosis . Surgery
Aim The purpose of this presentation is to demonstrate a surgical case of severe endometriosis involving a bladder endometriotic nodule.
Introduction Endometriosis involving the urinary tract is rare and only occurs in approximately 1 % of all patients with endometriosis [1]. Of these, bladder involvement is the most common accounting for 85 %, and the rest involves 10 % ureter, 4 % kidney and 2 % urethra [2]. When endometriosis infiltrates more than 5 mm beneath the peritoneum, it is defined as deeply infiltrating endometriosis. In the case of bladder involvement, endometriosis can infiltrate through bladder muscularis and even to the bladder mucosa. At cystoscopy, it has a typical appearance of a nodule with a bluish colour. Symptoms can vary from asymptomatic to suprapubic pain, dysuria, haematuria and recurrent urinary tract infection. Any bladder symptoms displayed are usually worst during menstruation. Asymptomatic patients can be managed conservatively. Medical treatment with hormonal therapy may control symptoms for
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