{"paper_id":"7cee414f-f583-4555-a026-ee579d1676d3","body_text":"Bladder endometriosis – diagnostic and management challenges: A case report\nDOI:\nhttps://doi.org/10.59692/jogeca.v36i1.138Abstract\nBackground: Urinary tract endometriosis (UTE) is the presence of endometriotic implants in the bladder,\nureter, kidneys, or urethra. It affects ~1% of women with endometriosis and occurs more commonly\namong those with deep infiltrative endometriosis. Bladder endometriosis is the most common\npresentation, comprising 85% of cases. Concomitant involvement of the bladder and ureter is rare,\ncomprising 1.4% of all cases. The clinical presentation involves lower urinary tract symptoms, that\nworsen during menses. Timely diagnosis and treatment are crucial in ameliorating symptoms and\npreventing complications, such as obstructive nephropathy. This is a case of bladder endometriosis with\nureteral involvement, outlining management challenges, reviewing evidence on management\napproaches, and highlighting the experience gained from this case in managing complex UTE.\nCase presentation: A 38-year-old female presented with a longstanding history of pelvic pain, dysuria,\nand new-onset voiding difficulty. She had undergone two prior surgical procedures for endometriosis,\nincluding a total abdominal hysterectomy. Her physical examination was normal. Ultrasound revealed a\n3-cm intracavitary bladder mass, which was described as likely endometriosis on magnetic resonance\nimaging. On cystoscopy the mass was noted to be larger, encasing the left ureteric meatus. A\nlaparoscopic cystostomy was performed, with partial resection of the mass and placement of a temporary\nureteric stent. After three months of medical treatment with dienogest, cystoscopy revealed a significant\nreduction in size with sub-centimeter residual avascular tissue. This was resected avoiding the ureter and\nureteric meatus. A new ureteric stent was placed. A repeat cystoscopy three months later revealed good\nhealing with no residual endometriosis. The stent was removed, and a retrograde pyelogram confirmed\nno meatal stenosis or ureteric obstruction. She has remained symptom-free.\nConclusion: Medical and surgical options are available for bladder endometriosis, with partial\ncystectomy being the gold standard. The initial approach is dependent on the size of the lesion and the\nextent of ureteric involvement. A staged approach that combines medical or surgical management can\nensure optimal outcomes while reducing surgery-associated morbidity in complex cases.\nDownloads\nPublished\nIssue\nSection\nCategories\nLicense\nCopyright (c) 2024 The Authors.\nThis work is licensed under a Creative Commons Attribution 4.0 International License.","source_license":"CC0","license_restricted":false}