A Review of Urinary Tract Endometriosis

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Urinary tract endometriosis may present with varied symptoms, requiring high clinical suspicion for diagnosis, with surgical resection offering durable symptom relief after initial hormonal palliation.

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This review describes the presenting signs and symptoms of urinary tract endometriosis, summarizes recommended evaluation, and reviews both hormonal and surgical therapies for symptom relief and definitive management. It highlights that urinary tract endometriosis can mimic interstitial cystitis, nephrolithiasis, bladder overactivity, or recurrent urinary tract infections, and may be cyclical or not; cyclical gross hematuria is described as pathognomonic, but confirmation requires pathologic review. The review states that unrecognized disease can lead to serious consequences such as silent renal loss from asymptomatic obstruction, and reports that surgical resection of implants appears to provide safe, durable symptom relief, typically following initial hormonal palliation with combined oral contraceptives. This paper is centrally about endometriosis — specifically urinary tract endometriosis and its clinical presentation, workup, and treatment.

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Abstract

PURPOSE OF REVIEW: To describe the presenting signs and symptoms of patients with urinary tract endometriosis (UTE), appropriate workup, and to review medical and surgical therapies for symptom palliation and definitive management. RECENT FINDINGS: UTE is a condition that clinicians should maintain a high index of suspicion for, as symptoms can be easily misdiagnosed from other causes. Surgical resection of implants appears to offer safe and durable symptom relief. Urinary tract endometriosis may present with symptoms overlapping with interstitial cystitis, nephrolithiasis, bladder overactivity, or recurrent urinary tract infections, and may or may not be cyclical in nature. Cyclical gross hematuria is considered pathognomonic, though final diagnosis must be made after a pathologic review. Without proper diagnosis and treatment, consequences such as silent renal loss from asymptomatic obstruction may result. After the diagnosis is made, initial therapy can be undertaken with hormonal treatment to palliate symptoms (most commonly in the form of combined oral contraceptives), followed by surgical resection for a definitive treatment option.
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Abstract

Purpose of Review To describe the presenting signs and symptoms of patients with urinary tract endometriosis (UTE), appropriate workup, and to review medical and surgical therapies for symptom palliation and definitive management. Recent Findings UTE is a condition that clinicians should maintain a high index of suspicion for, as symptoms can be easily misdiagnosed from other causes. Surgical resection of implants appears to offer safe and durable symptom relief. Summary Urinary tract endometriosis may present with symptoms overlapping with interstitial cystitis, nephrolithiasis, bladder overactivity, or recurrent urinary tract infections, and may or may not be cyclical in nature. Cyclical gross hematuria is considered pathognomonic, though final diagnosis must be made after a pathologic review. Without proper diagnosis and treatment, consequences such as silent renal loss from asymptomatic obstruction may result. After the diagnosis is made, initial therapy can be undertaken with hormonal treatment to palliate symptoms (most commonly in the form of combined oral contraceptives), followed by surgical resection for a definitive treatment option. Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance Acién P, Velasco I. Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol. 2013;2013: 242149. Kołodziej A, Krajewski W, Dołowy Ł, Hirnle L. Urinary tract endometriosis. Urol J. 2015;12(4):2213–7. Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451.e1-11. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223–36. Treloar SA, Bell TA, Nagle CM, Purdie DM, Green AC. Early menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstet Gynecol. 2010;202(6):534.e1-6. Farland LV, Eliassen AH, Tamimi RM, Spiegelman D, Michels KB, Missmer SA. History of breast feeding and risk of incident endometriosis: prospective cohort study. BMJ. 2017;29(358): j3778. Farland LV, Missmer SA, Bijon A, Gusto G, Gelot A, Clavel-Chapelon F, et al. Associations among body size across the life course, adult height and endometriosis. Hum Reprod Oxf Engl. 2017;32(8):1732–42. Endometriosis. ACOG [Internet]. [cited 2021 Sep 22]. Available from: https://www.acog.org/en/womens-health/faqs/endometriosis. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3):511–9. Halme J, Hammond MG, Hulka JF, Raj SG, Talbert LM. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984;64(2):151–4. Matsuura K, Ohtake H, Katabuchi H, Okamura H. Coelomic metaplasia theory of endometriosis: evidence from in vivo studies and an in vitro experimental model. Gynecol Obstet Invest. 1999;47(Suppl. 1):18–22. Suginami H. A reappraisal of the coelomic metaplasia theory by reviewing endometriosis occurring in unusual sites and instances. Am J Obstet Gynecol. 1991;165(1):214–8. Javert CT. The spread of benign and malignant endometrium in the lymphatic system with a note on coexisting vascular involvement. Am J Obstet Gynecol. 1952;64(4):780–806. Jensen JR, Coddington CC. Evolving spectrum: the pathogenesis of endometriosis. Clin Obstet Gynecol. 2010;53(2):379–88. Pathophysiology and Clinical Presentation | Endometriosis [Internet]. [cited 2021 Sep 22]. Available from: https://u.osu.edu/endometriosisinfo/pathophysiology-and-clinical-presentation/. • Shim JY, Laufer MR, Grimstad FW. Dysmenorrhea and endometriosis in transgender adolescents. J Pediatr Adolesc Gynecol. 2020;33(5):524–8. The reference discussing endometriosis symptoms in the adolescent transmale population highlights the ability of this disease to evade suspicion. The transgender population will become increasingly familiar to all healthcare providers, and it is crucial to be able to provide them high quality care. Gustilo-Ashby AM, Paraiso MFR. Treatment of urinary tract endometriosis. J Minim Invasive Gynecol. 2006;13(6):559–65. Shook TE, Nyberg LM. Endometriosis of the urinary tract. Urology. 1988;31(1):1–6. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod Oxf Engl. 2003;18(4):756–9. • Barocas DA, Boorjian SA, Alvarez RD, Downs TM, Gross CP, Hamilton BD, et al. Microhematuria: AUA/SUFU Guideline. J Urol. 2020;204(4):778–86. This article discusses the risk stratification and workup of a patient presenting with microscopic hematuria of an unidentified cause. Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2004;24(2):180–5. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16(2):285–98. Westney OL, Amundsen CL, McGuire EJ. Bladder endometriosis: conservative management. J Urol. 2000;163(6):1814–7. Yohannes P. Ureteral endometriosis. J Urol. 2003;170(1):20–5. Price DT, Maloney KE, Ibrahim GK, Cundiff GW, Leder RA, Anderson EE. Vesical endometriosis: report of two cases and review of the literature. Urology. 1996;48(4):639–43. Seracchioli R, Mabrouk M, Montanari G, Manuzzi L, Concetti S, Venturoli S. Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up. Fertil Steril. 2010;94(3):856–61. Kane C, Drouin P. Obstructive uropathy associated with endometriosis. Am J Obstet Gynecol. 1985;151(2):207–11. Yang J, Song R, Xu C, Zhang S, Zhang W. Renal endometriosis tends to be misdiagnosed as renal tumor: a rare case report. Int Surg. 2015;100(2):376–80. Matalliotakis IM, Arici A, Cakmak H, Goumenou AG, Koumantakis G, Mahutte NG. Familial aggregation of endometriosis in the Yale Series. Arch Gynecol Obstet. 2008;278(6):507–11. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of Interest The authors declare that they have no conflicts of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is part of the Topical Collection on Female Urology Rights and permissions Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Sherman, A.K., MacLachlan, L.S. A Review of Urinary Tract Endometriosis. Curr Urol Rep 23, 219–223 (2022). https://doi.org/10.1007/s11934-022-01107-8 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11934-022-01107-8

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endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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