Bladder endometriosis must be considered as bladder adenomyosis

OBJECTIVE: To present data from a series of 17 cases of bladder endometriosis. DESIGN: Clinical study. SETTING: A university hospital department of gynecology. PATIENT(S): Seventeen patients complaining of menstrual urinary symptoms and/or pelvic pain. INTERVENTION(S): Diagnosis and resection of a bladder adenomyotic nodule. MAIN OUTCOME MEASURE(S): Histologic analysis and postsurgical outcome. RESULT(S): Seventy-six percent of the patients reported menstrual mictalgia and pollakiuria, and 88% reported dysmenorrhea and dyspareunia. Cystoscopy, intravenous pyelography, and magnetic resonance imaging revealed a nodular mass in the anterior fornix adjacent to the uterine wall, developed in the vesical muscularis and involving the vesical mucosa in all cases but one. The bladder nodule was associated with a rectovaginal nodule in six cases (35%). Because recurrence was noted soon after cessation of medical therapy, surgical excision was proposed. The vesical mucosa was found to be intact in almost all cases, so extramucosal laparoscopic excision was the method of choice. Histologic examination proved that 90% of the nodule consisted of smooth muscle hyperplasia. CONCLUSION(S): So-called bladder endometriosis is actually an adenomyotic nodule of the bladder which, from a histologic point of view, is similar to a rectovaginal adenomyotic nodule and frequently (35%) associated with it.