OC34.02: Vesical endometriosis: sonographic diagnosis and follow up after surgery

The aim of this study was to review the sonographic aspects of bladder endometriosis and to evaluate the extension of the disease and associated symptoms. Ten patients had a TVS diagnosis of infiltrative bladder endometriosis. Excision of the suspected endometriotic lesion was performed by cystoscopy or laparoscopic partial cystectomy or transperitoneal cystotomy. Histological examination confirmed the endometriotic nature of bladder nodule in all cases. All patients suffer during menstruation with pelvic pain, 5 patients had macroscopic haematuria and 5 urinary urgency and frequency. Seven out of 10 patients had a previous uterine surgery, 6 had a cesarean section and one a myomectomy. The patients who have not undergone any previous surgery suffer with extensive pelvic endometriosis. TVS performed with filled bladder showed in the vesical wall an inhomogeneous solid nodular mass with irregular margin that in 8 cases extend also in the lumen of the bladder. These nodular masses appeared at TVS very similar to a vesical cancer, but showed, at power Doppler evaluation, very few vascolarization. All the endometriotic nodules were found on the posterior wall and in two patients also an extension to the fundal wall was noticed. Only one patient had a small recurrence one year after surgery Bladder endometriosis should be suspected in premenopausal patients who suffer with cyclical dysuria and haematuria. In this cases TVS should be performed with filled bladder. Endometriotic nodules appear as not vascularized, inhomogeneous, irregular solid tissue of the posterior vesical wall and are related often to previous surgery of the uterus.