The menstruating bladder, an unusual cause of haematuria

Gerald Busuttil, K. German, James DeGaetano, Albert P. Scerri
2012 · W2291287789
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This case report describes a 39-year-old woman with flank pain and hematuria whose ureteric obstruction and non-functioning kidney were caused by endometriosis of the bladder, successfully treated with hysterectomy and bilateral salpingo-oophorectomy.

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This 2012 case report describes a 39-year-old woman with flank pain and haematuria; imaging showed unilateral hydronephrosis and impaired renal function, and cystoscopy revealed a soft tissue mass at the left ureteric orifice causing obstruction. Biopsy and histology identified tubal-type epithelium compatible with endosalpingiosis, and later formal histology after more definitive surgery showed endometriosis in the resected specimen, with persistent symptoms leading to hysterectomy, bilateral salpingo-oophorectomy, and partial cystectomy. The major caveat is that the findings are limited to a single patient and cannot establish incidence or broader causal mechanisms. Relevance to endometriosis: the paper’s key diagnosis on final histology is urinary tract endometriosis (at the vesico-ureteric junction), reported as an unusual cause of haematuria.

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Abstract

A 39 year old lady presented with flank pain and haematuria. Radiological investigations showed unilateral hydronephrosis and a serum creatinine of 102?mol/l. At cystoscopy, a soft tissue mass was found in the region of the left ureteric orifice and was causing obstruction of the ureter. A resection biopsy of this lesion was taken. A CT scan and DTPA renogram showed a non-functioning left kidney secondary to chronic obstruction by a soft tissue mass at the left vesico-ureteric junction. Histological analysis of the endoscopic resection specimen showed that the mass contained tubal-type epithelium compatible with a diagnosis of endosalpingiosis (a rare variant of Mullerianosis of the urinary tract). In view of persistent symptoms, it was decided to proceed to surgery. A hysterectomy, bilateral salpingo-oophorectomy and partial cystectomy were performed. The patient has recovered well and is currently asymptomatic. Formal histology of the resection specimen showed the presence of endometriosis.
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Please use this identifier to cite or link to this item: https://www.um.edu.mt/library/oar/handle/123456789/1143 | Title: | The menstruating bladder, an unusual cause of haematuria | | Authors: | Busuttil, Gerald German, Karl Andrew DeGaetano, James Scerri, Albert P. | | Keywords: | Hematuria -- Malta -- Case studies Hematuria -- Etiology Ureteral obstruction | | Issue Date: | 2012 | | Publisher: | Malta Medical Journal | | Citation: | Busuttil, G., German, K., DeGaetano, J., & Scerri, A. P. (2012). The menstruating bladder, an unusual cause of haematuria. Malta Medical Journal, 24(2), 35-38. | | Abstract: | A 39 year old lady presented with flank pain and haematuria. Radiological investigations showed unilateral hydronephrosis and a serum creatinine of 102?mol/l. At cystoscopy, a soft tissue mass was found in the region of the left ureteric orifice and was causing obstruction of the ureter. A resection biopsy of this lesion was taken. A CT scan and DTPA renogram showed a non-functioning left kidney secondary to chronic obstruction by a soft tissue mass at the left vesico-ureteric junction. Histological analysis of the endoscopic resection specimen showed that the mass contained tubal-type epithelium compatible with a diagnosis of endosalpingiosis (a rare variant of Mullerianosis of the urinary tract). In view of persistent symptoms, it was decided to proceed to surgery. A hysterectomy, bilateral salpingo-oophorectomy and partial cystectomy were performed. The patient has recovered well and is currently asymptomatic. Formal histology of the resection specimen showed the presence of endometriosis. | | URI: | https://www.um.edu.mt/library/oar//handle/123456789/1143 | | Appears in Collections: | MMJ, Volume 24, Issue 2 MMJ, Volume 24, Issue 2 Scholarly Works - FacM&SOG Scholarly Works - FacM&SPat Scholarly Works - FacM&SSur | Files in This Item: | File | Description | Size | Format | | |---|---|---|---|---| | 2012.Vol24.Issue2.A7.pdf | The menstruating bladder, an unusual cause of haematuria | 254.25 kB | Adobe PDF | View/Open | Items in OAR@UM are protected by copyright, with all rights reserved, unless otherwise indicated.

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