VP05.08: Ultrasound and surgical excision of a large endometriotic bladder nodule

In this case review we will consider and correlate the history, sonographic, laparoscopic and cystoscopic findings of a woman with a large endometriotic lesion of the bladder. Ultrasound images and surgical video will be used. A 43-year-old presented to clinic with a three-year history of progressively worse menstrual dysuria (9/10). To a lesser extent she experiences dyschezia (6/10) and dysmenorrhoea (5/10). These symptoms have been present and progressively worsening for 3 years. She has secondary infertility. She miscarried a spontaneous pregnancy five years ago and has been infertile since. The couple have had one failed IUI attempt followed by IVF with 3 failed blastocyst transfers. The couple had a diagnostic laparoscopy at another centre where severe endometriosis was noted but not excised. She is otherwise fit and well and works in early childhood education. A pelvic ultrasound demonstrated a 46 x 35 x 16mm nodule in the posterior bladder dome. The lesion appeared to arise from the muscularis layer and was fixed within the anterior uterovessical fold. In addition, there was a 16 x 15 x 10mm superficial lesion on the adjacent uterovessical fold as well as a 14 x 10 x 8 mm pouch of Douglas lesion. A laparoscopy was performed and the lesion was excised via cystotomy, under cystoscopic guidance. She made an unremarkable recovery. Post operatively she has had resolution of her symptoms and will attempt transfer of her remaining blastocysts. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.