OP20.03: Bladder endometriosis: songraphic features useful for surgical treatment

The aim of this study was to review the sonographic aspects of bladder endometriosis and to establish their usefulness for surgical management. 51 patients with histologically confirmed bladder endometriosis underwent sonographic evaluation prior to surgical treatment. 2D and 3D transvaginal sonography was performed with moderate filled bladder and had a diagnosis of infiltrative bladder endometriosis. A mapping of the disease extension was evaluated, vescical nodules were measured in three diameters, position, echostructure and tissue infiltration of the mucosa were accurately described. Distances from the ureteres were measured. Presence of sonographic signs of endometriomas, posterior deep infiltrating endometriosis and adenomyosis were also noted. Excision of the suspected endometriotic lesion was performed by laparoscopic partial cystectomy or transperitoneal cystotomy. Presurgical cystoscopic application of ureteral stent was notified. 44 patients had dysmenorrhea, 15 macroscopic haematuria and 48 painful urinary symptoms. In 42 cases the lesion appeared as an inhomogeneous hyperechoic, solid, nodular mass of the vescical wall, in 31 cases also extending in the lumen of the bladder. These nodular masses showed small hypoechoich cystic areas inside in 28 cases and at power Doppler evaluation few vascularization in 42 cases. All the endometriotic nodules were found on the posterior bladder wall and in two patients also an extension to the fundal wall was noticed. Mean diameter of the bladder lesions was 23.1 ± 8.1 mm. Mean distance from the closest ureter was 9.1 ± 8.3 mm. 26 patients had a previous uterine surgery, of these 18 had a Caesarean section and 8 a myomectomy. 32 patients had previous surgery for pelvic endometriosis. Sonographic signs of adenomyosis were found in 28 out of 44 patients. History of pelvic endometriosis and adenomyosis, nodule size and distance from the ureters are important features to guide surgical management of bladder endometriosis.