Human Reproduction vol.12 no. 11 pp.2519-2522, 1997 Pre-operative assessment of bladder endometriosis

The aim of our study was to verify the reliability of transvaginal ultrasonography in the pre-operative evalu-ation of bladder endometriosis. Six patients with suspected bladder endometriosis were studied. At referral to our department all six women underwent magnetic resonance imaging (MRI), transabdominal and transvaginal ultra-sonography, cystoscopy and descending urography. Sub-sequently all the women underwent transperitoneal cystotomy and excision of endometriotic lesion at laparo-tomy. In three patients the bladder endometriotic lesions were continuous with adenomyosis in the anterior uterine wall. Histological examination confirmed the endometriotic nature of bladder nodule in all cases. Abdominal ultrasono-graphy visualized the detrusor neoformation in all the patients but was less precise than transvaginal ultrasono-graphy and MRI in defining the size of the lesions, infiltra-tion of the detrusor and continuity with extravesical lesions. Transvaginal ultrasonography was more accurate and ver-satile than abdominal ultrasonography. The better image resolution allowed an accurate structural analysis of the bladder wall lesion. Furthermore, involvement of the uterovesical septum could be evaluated and adjacent myometrial infiltration recognized. MRI, although very precise, was less versatile than transvaginal ultrasono-graphy and less accurate in establishing the margins of the lesions as perilesional fibrosis is visualized less clearly than areas containing haematic material. Urography was aspecific but still useful to evaluate the integrity of the upper urinary tract and ureters. In conclusion, in our patients transvaginal ultrasonography was found to be the most accurate technique in the diagnosis of bladder endometriosis. Key words: bladder/endometriosis/transvaginal ultrasonography