Postcesarean Versus Primary Bladder Endometriosis and Coexistent Pelvic Endometriosis: A Systematic Review

Noemi Salmeri, Camilla Buffo, Alessia Ragusi, Edgardo Somigliana, Paola Viganò, Paolo Vercellini
Journal of minimally invasive gynecology · 2025 · vol. 33(2) , pp. 178–186 · doi:10.1016/j.jmig.2025.08.012 · PMID:40825439 · W4413292089
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This systematic review found coexistent pelvic endometriosis was significantly less frequent in postcesarean bladder endometriosis compared to primary bladder endometriosis.

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Abstract

OBJECTIVE: To investigate the prevalence of coexisting pelvic lesions in postcesarean bladder endometriosis (BE) and primary BE. If women with postcesarean BE exhibit a lower prevalence of coexistent endometriosis, it could be hypothesized that peritoneal damage of the vesicouterine fold, coupled with surgical dissemination of decidual fragments may be sufficient per se for lesion development. DATA SOURCES: Systematic search conducted in PubMed, Embase, and Scopus up to March 20th, 2025. METHODS OF STUDY SELECTION: Eligibility was defined using the PICOS framework: women with postcesarean BE (Population); full pelvic assessment with surgical or imaging-based confirmation of endometriosis (Intervention); women with primary BE and no prior cesarean section (CS) (Comparator); presence of endometriosis beyond the bladder (Outcome); and case reports or series providing sufficient clinical/surgical details (Study type). Studies were evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. The review followed PRISMA 2020 guidelines. No formal analysis was performed due to the descriptive nature of the data, but crude proportions were compared using Fisher's exact test. TABULATION, INTEGRATION, AND RESULTS: Of 7378 records identified, 4499 were screened and 374 full texts assessed. Eighty-one studies were included, accounting for 117 women with BE (26 postcesarean, 91 primary). Coexistent pelvic endometriosis was significantly less frequent in postcesarean BE (19.2%) than primary BE (79.1%) (p < .0001). The odds of concomitant pelvic endometriosis were approximately 16 times lower in postcesarean BE compared to primary BE (OR 0.06; 95% Confidence Interval, 0.02-0.20). In the limited number of postcesarean cases with coexistent pelvic endometriosis, lesions were restricted to few 2021 #Enzian compartments. CONCLUSION: Peritoneal injury followed by iatrogenic dissemination of endometrial fragments during CS may be sufficient per se to cause BE, regardless of individual predisposition. Therefore, adopting surgical techniques that potentially reduce the risk of this long-term postcesarean complication should be recommended.

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Outcome instruments

Enzian

Condition tags

mesh:D004715endometriosisbladder_endometriosis

MeSH descriptors

Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Cesarean Section Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (2)

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europepmc
last seen: 2026-06-04T01:30:01.192114+00:00
openalex
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pubmed
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License: CC0 · commercial use OK