Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis

Stacy Young, Megan Kennedy Burns, Lucia DiFrancesco, Azadeh Nezhat, Camran Nezhat
Journal of the Turkish German Gynecological Association · 2017 · vol. 18(4) , pp. 200–209 · doi:10.4274/jtgga.2017.0143 · PMID:29278234 · W2777823874
article OA: diamond CC0 ⤵ 24 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review outlines diagnostic challenges and recommends management strategies for gastrointestinal and genitourinary endometriosis, emphasizing surgical intervention for ureteral obstruction and conservative approaches for bladder or bowel involvement.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper reviews gastrointestinal and genitourinary endometriosis, focusing on epidemiology, proposed pathogenesis, and detailed diagnostic and management considerations. It synthesizes evidence that gastrointestinal endometriosis most often involves the rectosigmoid region and that symptom patterns such as deep dyspareunia, catamenial bowel symptoms, and rectal bleeding can raise suspicion; it then summarizes medical options (hormonal suppression and related therapies) and surgical strategies for symptomatic cases, emphasizing that medical therapy can improve symptoms for many but that a substantial fraction proceed to surgery. The authors describe laparoscopic approaches when feasible and compare shaving excision, disc excision, and segmental resection, while noting limitations and recurrence/complication tradeoffs, including the controversy over rectal/sigmoid surgery and the possibility of occult microscopic disease. This paper is centrally about endometriosis — specifically diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis.

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Abstract

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

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Condition tags

endometriosisbowel_endometriosisbladder_endometriosisinterstitial_cystitisirritable_bowel_syndrome

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.

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Cited by (24)

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