Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis – a narrative review

Masatomo Kaneko, André Luiz Lima Diniz, Atsuko Fujihara, José Anacleto Dutra de Resende Júnior, Tsuyoshi Iwata, Cláudio M. de Andrade, Alice C. Brandão, Lorenzo Storino Ramacciotti, Suzanne L Palmer, Mauro Poggiali Gasparoni, Luciano A. Favorito, Masakatsu Oishi, Manju Aron, Giovanni E Cacciamani, Vinay Duddalwar, Go Horiguchi, Satoshi Teramukai, Osamu Ukimura, Inderbir S Gill, Andre Luis Abreu
International braz j urol : official journal of the Brazilian Society of Urology · 2023 · vol. 49(5) , pp. 564–579 · doi:10.1590/s1677-5538.ibju.2023.9907 · PMID:37450770 · W4384401384
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review examines how urological knowledge and tools like ultrasonography, MRI, and laparoscopy aid in diagnosing and surgically treating deep infiltrating endometriosis affecting the urinary tract.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This narrative review examined the diagnosis and surgical management of deep infiltrating endometriosis (DIE) affecting the urinary tract, using a search of PubMed, Embase, and SciELO with MeSH terms related to endometriosis, urology, bladder, and ureteral involvement, followed by PRISMA-guided selection. From 105 initially identified records, 34 articles were included, and the review reports that urinary system involvement is present in 52.6% of DIE patients; it summarizes diagnostic performance for transvaginal ultrasonography, cystoscopy, and magnetic resonance imaging, and describes intraoperative endourological assessment and common laparoscopic approaches. Major limitations explicitly noted include the lack of randomized clinical trials and the limited number of high-level evidence studies, alongside reliance on observational designs and smaller cohorts in much of the literature. This paper is centrally about endometriosis — it specifically reviews urological diagnosis tools and surgical techniques for deep infiltrating endometriosis involving the bladder and ureters.

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Abstract

Objectives: This review discusses deep infiltrating endometriosis (DIE) diagnosis and surgery using current urological knowledge and technologies. Materials and Methods: Narrative review of deep infiltrating endometriosis that result in urological issues. We examined manuscripts from Pubmed, Embase, and Scielo’s database using the following MeSH terms: (‘endometriosis’) AND (‘urology’ OR ‘urological’ OR ‘urologist’) AND (‘bladder’ OR’vesical’) AND (‘ureteral’ OR ‘ureter’). Selection followed PRISMA guidelines. Sample images from our records were brought to endorse the findings. Results: Thirty four related articles were chosen from 105. DIE may affect the urinary system in 52.6% of patients. Lower urinary tract symptoms may require urodynamic examination. Ultrasonography offers strong statistical yields for detecting urinary tract lesions or distortions, but magnetic resonance will confirm the diagnosis. Cystoscopy can detect active lesions, although any macroscopic visual appeal is pathognomonic. Endourology is utilized intraoperatively for bladder and ureteral assessment, however transurethral endoscopic excision of bladder lesions had higher recurrence rates. Laparoscopy is the route of choice for treatment; partial cystectomy, and bladder shaving were the most prevalent surgical treatments for bladder endometriosis. Regarding the ureteral treatment, the simple ureterolysis and complex reconstructive techniques were described in most papers. Using anatomical landmarks or neuronavigation, pelvic surgical systematization allows intraoperative neural structure identification. Conclusions: DIE in the urinary system is common, however the number of publications with high level of evidence is limited. The initial tools for diagnosis are ultrasonography and cystoscopy, but magnetic resonance is the most reliable tool. When the patient has voiding symptoms, the urodynamic examination is crucial. Laparoscopy improves lesion detection and anatomical understanding. This approach must be carried out by professionals with high expertise, since the surgery goes beyond the resection of lesions and includes the preservation of nerve structures and urinary tract reconstruction techniques.

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Condition tags

endometriosisdie_deep_infiltratingbladder_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Laparoscopy Laparoscopy

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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