Laparoscopic partial cystectomy for bladder endometriosis

M. Sami Walid; Walid MS; Heaton RL; Richard L. Heaton

doi:10.1007/s00404-008-0856-4

Laparoscopic partial cystectomy for bladder endometriosis

M. Sami Walid, Walid MS, Heaton RL, Richard L. Heaton

Archives of gynecology and obstetrics · 2009 · doi:10.1007/s00404-008-0856-4 · PMID:19052759

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This case report demonstrates that laparoscopic partial cystectomy can be safely performed for bladder endometriosis involving the trigone and ureteral orifice, challenging previous recommendations to exclude such cases.

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This case report describes the successful laparoscopic partial cystectomy performed on a 32-year-old woman with biopsy-proven bladder endometriosis that penetrated the bladder wall and mucosa near the trigone. The authors argue against previous recommendations to exclude patients with lesions close to the ureteral orifices, stating that such cases can be safely managed if the surgeon possesses advanced pelvic dissection and suturing skills. The procedure required careful assessment via cystoscopy to determine the extent of involvement and placement of ureteral stents when necessary. This paper is centrally about endometriosis — specifically the surgical management of deep infiltrating lesions involving the bladder.

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Abstract

Laparoscopic partial cystectomy performed for bladder endometriosis in selected patients requires advanced laparoscopic skills including pelvic dissection, suturing and intracorporeal knot tying. Cystoscopic skills to assess the extent of endometriosis involvement in the bladder and to place ureteral stents if endometriosis involves or is close to the trigone, ureters, or projected course of the intramural part of the ureter are also required. Previous authors have recommended the laparoscopic technique only with bladder endometriosis that is distant from the bladder neck, the ureteral orifices, and the trigone, to allow a resection margin of 1-2 cm. We find no reason to exclude patients with these involvements if the surgeon can safely do the resection and reconstruction. We report a 32-year-old patient referred by her urologist for the evaluation and treatment of biopsy-proven bladder endometriosis penetrating the bladder wall and mucosa above and to the right of the midline of the trigone approximately 1.5 in. in diameter with fibrotic scarring extending to the trigone and very close to the right ureteral orifice. The patient successfully underwent partial laparoscopic cystectomy as described in the body of the paper.

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Abstract

Laparoscopic partial cystectomy performed for bladder endometriosis in selected patients requires advanced laparoscopic skills including pelvic dissection, suturing and intracorporeal knot tying. Cystoscopic skills to assess the extent of endometriosis involvement in the bladder and to place ureteral stents if endometriosis involves or is close to the trigone, ureters, or projected course of the intramural part of the ureter are also required. Previous authors have recommended the laparoscopic technique only with bladder endometriosis that is distant from the bladder neck, the ureteral orifices, and the trigone, to allow a resection margin of 1–2 cm. We find no reason to exclude patients with these involvements if the surgeon can safely do the resection and reconstruction. We report a 32-year-old patient referred by her urologist for the evaluation and treatment of biopsy-proven bladder endometriosis penetrating the bladder wall and mucosa above and to the right of the midline of the trigone approximately 1.5 in. in diameter with fibrotic scarring extending to the trigone and very close to the right ureteral orifice. The patient successfully underwent partial laparoscopic cystectomy as described in the body of the paper.

References

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Condition tags

endometriosisbladder_endometriosis

MeSH descriptors

Cystectomy Endometriosis Urinary Bladder Diseases Adult Cystectomy Endometriosis Endometriosis Female Humans Laparoscopy Laparoscopy Suture Techniques Urinary Bladder Urinary Bladder Urinary Bladder Urinary Bladder Diseases Urinary Bladder Diseases

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