{"paper_id":"b714d3e2-0dd2-4078-a474-11e9b147d5c0","body_text":"Case Report ISSN: 2056-4546\nIntegrative Cancer Science and Therapeutics\nIntegr Cancer Sci Therap, 2019      doi: 10.15761/ICST .1000310\n Volume 6: 1-2\nCombined transurethral resection and laparoscopic paritial \ncystectomy for the treatment of bladder endometriosis: A \ncase report\nXiaobo Huang1,2, Hubisihaletu3, Liang Gu3, Yonghua Wu3, Haiyun Ye1,2 and Qingquan Xu1,2*\n1Urology and lithotripsy Center, Peking University People’s Hospital, China\n2Peking University Applied lithotripsy Institute, China\n3Department of Surgery, People’s Hospital of Ijinholuo Banner, China\nAbstract\nWe report a case of 44-year-old women who was found to have a bladder mass on abdomen ultrasonography. The mass was confirmed by computed tomography. \nCystoscopy and biopsy were performed, the pathological finding was chronic inflammation. Then laparoscopic combined transurethral surgery was performed to \nresect the mass. The final pathological result was bladder endometriosis. \n*Correspondence to: Qingquan Xu, MD, Urology and Lithotripsy Center, \nPeking University People’s Hospital, 133 Fuchengmennei Street, Beijing, \n100034, China, Tel: 86-10-66583720, E-mail: xuqingquan@pkuph.edu.cn\nKey words: bladder, endometriosis, laparoscopic, transurethral, partial cystectomy\nReceived: February 20, 2019; Accepted: May 28, 2019; Published: June 01, 2019\nBackground\nBladder endometriosis is defined as the presence of endometrial \nglands and stroma in the detrusor muscle. The base and the dome are the \nmost frequently affected sites. The pathogenesis, diagnosis, treatment of \nbladder endometriosis were peerly reviewed [1]. laparoscopic partial \ncystectomy is an effective technique with excellent long term results. \nHowever, this procedure may lead to inadvertent removal of healthy \nbladder muscle. Here, we reported a case of bladder endometriosis. The \nlesion was removed by a combination of transurethral resection and \nlaparoscopic surgery. \nCase report\nA 44-year-old women was found to have a bladder mass by \nabdomen ultrasonograpy. She had a previous history of Cesarean \ndelivery and Hysterectomy. Cystoscopy and biopsy was performed \nand found that the mass located within the posterior bladder wall \nand was covered with mucosa. The pathological finding was chronic \ninflammation. Then she was refered to our hospital. The contrast CT \nscan confirmed the location of the mass. The mass contained solid \nand cystic components and protruded into the bladder lumen. We \ndecided to perform partial cystectomy combined of transurethral \nresection technique. \nUnder general anesthesia, the patient was set in lithotomy position. \nThe pneumoperitoneum was obtained by Veress needle technique. \nThe laparoscopic procedure was performed transperitoneally with \na three-port arrangement. A 10mm trocar was inserted above the \numbilical scar. The 30° laparoscope was inserted. Two 12-mm trocars \nwere introduced in the right and left lower quadrant of the abdomen \nunder vision respectively. The adhesion of omentum with bladder \nwith released by ultrasonic scissors at first. A transurethral Colling’s \nknife was used to make a circumferential mucosomuscular incision \naround the mass (Figure 1). It’s very easy to locate the resection line by \nturning off the light of laparoscope (Figure 2). The mass was completely \nFigure 1. Cystoscopic view. A transurethral Colling’s knife was used to make a \ncircumferential mucosomuscular incision around the mass\nremoved around the line with ultrasonic scissors (Figure 3). The defect \nof the bladder wall was closed by running suture with 3-0 V-lck sutures \n(Figure 4). The urethral catheter was removed on day 7 postoperatively. \nEndometrial gland and stroma were found on pathological study and \nbladder endometriosis was confirmed.\nDiscussion\nEndometriosis is defined by the presence of endometrial \nglandular epithelium and stroma implants in extra-uterine location. \nEndometriosis is a common gynecologic disease affecting women of \nreproductive age. The estimates of incidence of endometriosis vary from \n\nHuang X (2019) Combined transurethral resection and laparoscopic paritial cystectomy for the treatment of bladder endometriosis: A case report\nIntegr Cancer Sci Therap, 2019      doi: 10.15761/ICST .1000310\n Volume 6: 2-2\n<10% t0 >20% of women [2]. Typical sites include the ovaries, fallopian \ntubes, pelvic peritoneum, and uterosacral ligaments. The atypical \nsites of endometriosis involves gastrointestinal tract, urinary tract, \nabdomen wall, chest and adrenal [3-5]. Urinary tract endometriosis \naccounts for 0.2% of endometriosis in a retrospective review of 1376 \npathologic reports [5].  Although considered rare, endometriosis of the \nurinary tract might be more common than previously thought owing to \nchanging definition and a lack of recognition by surgeons [2]. bladder \ninvolvement is the most frequent type of urinary tract endometriosis, \noccurring in 70%-85% of cases [1]. Audebert and colleague reported \nthe anatomic distribution of endometriosis. In their series, bladder was \nthe site of superficial implants or endometriotic nodes in 21.5% patients \n[6]. Most bladder endometriosis patients present with lower urinary \ntract symptoms, haematuria. The symptoms may worsen during \nmenstruation [1].\nThe pathophysiology of endometriosis remains elusive. Retrograde \nmenstruation is the most commonly accepted theory. Other theories \ninclude coelomic metaplasia, dysregulation of the immune system and \niatrogenic endometriosis implant [2].\nTreatment options are considered based on symptom and the \nsite of the lesions. Hormonal therapy is generally used for temporary \nrelieving the symptom. And surgical excision of the lesion is the \ntreatment of choice [2]. Laparoscopic partial cystectomy is the \npreferable surgery for bladder endometriosis. It is difficult to identify \nthe correct margin of the lesion during procedure [2]. At this time, \ncombining cystoscopy could quickly locate and ensure the correct \nmargins. Different authors have described the combination of \ncystoscopy and laparoscopy for bladder endometriosis resection \n[7-11]. We made a circumcision line around the lesion with a \ntransurethral collings’s knife. The margin of the lesion could be easily \nfound by switching off the light of the laparoscope. The lesion could \nbe removed en bloc just following the marking line. This combination \nstrategy made the procedure safe and efficacious.\nReferences\n1. Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Vigano P, et al. \n(2017) Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, \nTreatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol 71: \n790-807. [Crossref]\n2. Nezhat C, Falik R, McKinney S, King LP (2017) Pathophysiology and management of \nurinary tract endometriosis. Nat Rev Urol 14: 359-372. [Crossref] \n3. Sonavane SK, Kantawala KP, Menias CO (2011) Beyond the boundaries-endometriosis: \ntypical and atypical locations. Curr Probl Diagn Radiol 40: 219-232. [Crossref]\n4. Joseph J, Sahn SA (1996) Thoracic endometriosis syndrome: new observations from an \nanalysis of 110 cases. Am J Med 100: 164-170. [Crossref] \n5. Lee HJ, Park YM, Jee BC, Kim YB, Suh CS (2015) Various anatomic locations of \nsurgically proven endometriosis: A single-center experience. Obstet Gynecol Sci 58: \n53-58. [Crossref]\n6. Audebert A, Petousis S, Margioula-Siarkou C, Ravanos K, Prapas N, et al. (2018) \nAnatomic distribution of endometriosis: A reappraisal based on series of 1101 patients. \nEur J Obstet Gynecol Reprod Biol 230: 36-40. [Crossref]\n7. Perez-Utrilla Perez M, Aguilera Bazan A, Alonso Dorrego JM, Hernandez A, de \nFrancisco MG, et al. (2009) Urinary tract endometriosis: clinical, diagnostic, and \ntherapeutic aspects. Urology 73: 47-51. [Crossref]\n8. Roman H, Arambage K, Pasquier G, Resch B, Huet E (2014) Combined cystoscopic \nand laparoscopic approach in deep endometriosis of the bladder. J Minim Invasive \nGynecol 21: 978-979. [Crossref]\n9. Litta P, Saccardi C, D’Agostino G, Florio P, De Zorzi L, et al. (2012) Combined \ntransurethral approach with Versapoint((R)) and laparoscopic treatment in the \nmanagement of bladder endometriosis: technique and 12 months follow-up. Surg \nEndosc 26: 2446-2450. [Crossref]\n10. Pang ST, Chao A, Wang CJ, Lin G, Lee CL (2008) Transurethral partial cystectomy and \nlaparoscopic reconstruction for the management of bladder endometriosis. Fertil Steril \n90: 2014. e1-3. [Crossref]\n11. Sener A, Chew BH, Duvdevani M, Brock GB, Vilos GA, et al. (2006) Combined \ntransurethral and laparoscopic partial cystectomy and robot-assisted bladder repair \nfor the treatment of bladder endometrioma. J Minim Invasive Gynecol  13: 245-248. \n[Crossref]\nFigure 2. Laparoscopic view. Locate the marked line by switching off the light of \nlaparoscope\nFigure 3. Laparoscopic view. The mass was removed en bloc around the line with \nultrasonic scissors\nFigure 4. The defect of the bladder wall was closed by running suture with a 3-0 V-lck \nsutures\nCopyright: ©2019 Huang X. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, \ndistribution, and reproduction in any medium, provided the original author and source are credited.","source_license":"CC0","license_restricted":false}