P48.02: Sonographic diagnosis of bladder endometriosis

The aim of this study was to review the sonographic aspects of bladder endometriosis and to evaluate extension of the disease and associated symptoms. Fourteen patients with bladder endometriosis underwent sonographic evaluation prior to surgical treatment. All the patients underwent 2D and 3D transvaginal (TVS) and transrectal (TRS) sonography for pelvic endometriosis. An accurate mapping of the extension of the disease was performed, the vescical nodules were measured in three diameters and the echostructure and tissue infiltration were accurately described. Presence of sonographic signs of endomatriomas, posterior deep infiltrating endometriosis (DIE) and adenomyosis were also reported. Histological examination confirmed the endometriotic nature of bladder nodule in all cases. Nine patients suffer with dysmenorehea, five patients had macroscopic haematuria and seven painful urinary symptoms. TVS performed with filled bladder showed in the vesical wall an inhomogeneous hyperechoic, solid, nodular mass with irregular margin that extended in the lumen of the bladder. These nodular masses showed often a small hypoechoic cystic areas inside and at power Doppler evaluation, very few vascularization. In 10 out of 14 patients who had a previous uterine surgery, eight had a Cesarean section and two a myomectomy. Eleven patients had previous surgery for pelvic endometriosis. Sonographic signs of adenomyosis were found in nine out of 14 patients. The patients who have not undergone any previous surgery suffer with extensive pelvic DIE. Bladder endometriosis should be suspected in premenopausal patients who suffer with cyclical painful urinary symptoms. In this cases TVS should be performed with filled bladder. Endometriotic nodules appear as a vascolarized, hyperechoic, irregular solid tissue of the posterior vesical wall and are related often to previous surgery of the uterus and to posterior DIE.