{"paper_id":"2e4c86ea-585b-42ff-acd1-75d2a45a7f8d","body_text":"Abstract\nBackground\nWhen endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1–2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint® and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up.\nMethods\nWe performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint®). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o’clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE®. The bladder hole was repaired with a continuous 3–0 monofilament two-layer suture.\nResults\nOperating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up.\nConclusions\nA combined transurethral approach with Versapoint® and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.\nSimilar content being viewed by others\nReferences\nGiudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799\nViganò P, Parazzini F, Somigliana E, Vercellini P (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 18(2):177–200\nKoninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55(4):759–765\nPastor-Navarro H, Giménez-Bachs JM, Donate-Moreno MJ, Pastor-Guzman JM, Ruíz-Mondéjar R, Atienzar-Tobarra M, Salinas-Sánchez AS, Virserda-Rodriguez JA (2007) Update on the diagnosis and treatment of bladder endometriosis. Int Urogynecol J 18:949–954\nVercellini P, Meschia M, De Giorgio O, Panazza S, Cortesi I, Crosignani PG (1996) Bladder detrusor endometriosis: clinical and pathogenetic implications. J Urol 155:770–771\nAbrao MS, Dias JA Jr, Bellelis P, Podgaec S, Bautzer CR, Gromatsky C (2009) Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril 91(5):1662–1667\nChapron C, Bourret A, Chopin N, Dousset B, Leconte M, Amsellem-Ouazana D, de Ziegler D, Borghese B (2010) Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Hum Reprod 25(4):884–889\nPérez-Utrilla Pérez M, Aguilera Bazán A, Alonso Dorrego JM, Hernández A, de Francisco MG, Martín Hernández M, de Santiago J, de la Peña Barthel J (2009) Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects. Urology 73(1):47–51\nGranese R, Candiani M, Perino A, Venezia R, Cucinella G (2008) Bladder endometriosis: laparoscopic treatment and follow-up. Eur J Obstet Gynecol Reprod Biol 140(1):114–117\nPang ST, Chao A, Wang CJ, Lin G, Lee CL (2008) Transurethral partial cystectomy and laparoscopic reconstruction for the management of bladder endometriosis. Fertil Steril 90(5):2014.e1–2014.e3\nSeracchioli R, Mannini D, Colombo FM, Vianello F, Reggiani A, Venturoli S (2002) Cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis. J Endourol 16(9):663–666\nNerli RB, Reddy M, Koura AC, Prabha V, Ravish IR, Amarkhed S (2008) Cystoscopy-assisted laparoscopic partial cystectomy. J Endourol 22(1):83–86\nBerlanda N, Vercellini P, Carmignani L, Aimi G, Amicarelli F, Fedele L (2009) Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv 64(12):830–842\nNezhat CH, Malik S, Osias J, Nezhat F, Nezhat C (2002) Laparoscopic management of 15 patients with infiltrating endometriosis of the bladder and a case of primary intravesical endometrioid adenosarcoma. Fertil Steril 78(4):872–875\nAntonelli A, Simeone C, Zani D, Sacconi T, Minini G, Canossi E, Cunico SC (2006) Clinical aspects and surgical treatment of urinary tract endometriosis: our experience with 31 cases. Eur Urol 49(6):1093–1097 discussion 1097–1098\nKovoor E, Nassif J, Miranda-Mendoza I, Wattiez A (2010) Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol 17(5):600–604\nLousquy R, Borghese B, Chapron C (2010) Deep bladder endometriosis: how do I… to perform a laparoscopic partial cystectomy? Gynecol Obstet Fertil 38:697–699\nSener A, Chew BH, Duvdevani M, Brock GB, Vilos GA, Pautler SE (2006) Combined transurethral and laparoscopic partial cystectomy and robot-assisted bladder repair for the treatment of bladder endometrioma. J Minim Invasive Gynecol 13(3):245–248\nFedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N, Carmignani L (2005) Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril 83(6):1729–1733\nDisclosures\nDrs. Pietro Litta, Carlo Saccardi, Giulia D’Agostino, Pasquale Florio, Luca De Zorzi, and Massimo Dal Bianco have no conflicts of interest or financial ties to disclose.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nLitta, P., Saccardi, C., D’Agostino, G. et al. Combined transurethral approach with Versapoint® and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up. Surg Endosc 26, 2446–2450 (2012). https://doi.org/10.1007/s00464-012-2208-5\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00464-012-2208-5","source_license":"CC0","license_restricted":false}