Bladder endometriosis in a patient with undirected manifestations, a rare case report.

Bladder endometriosis in a patient with undirected manifestations, a rare case report. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Bladder endometriosis in a patient with undirected manifestations, a rare case report. Ahmad Alhamid This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5939086/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Key clinical message Endometriosis is defined as the presence of functional glands and stroma of the uterus outside its cavity. It affects 10-20% of women of reproductive age. It can form in different body parts; the involvement of the urinary tract is rare (1% of all cases). We report here a case of a 37-year-old woman who presented to the clinic with urinary hesitancy, dysuria, suprapubic pain, and intermittent hematuria for a year, the patient experienced dysmenorrhea, irregular menstruation, dyspareunia, and pelvic pain from three years until now. According to the patient, these symptoms did not follow a specific pattern related to menstruation. The laboratory findings included hematuria and an International Normalized Ratio of 2.5, other investigations were within normal. The radiological investigations revealed a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder. Many differential diagnoses were made such as uterine mass, bladder neoplasm, bladder endometriosis, foreign body, and sarcoma. The surgical approach was indicated to excise the mass and know its nature. A solid mass was found on the posterior wall of the bladder, it was excised. The patient was discharged from the hospital after two days in a good situation and without complications. The histopathological examination of the excised masse revealed benign endometriosis. She was followed for two years postoperatively without any recurrence. Obstetrics & Gynecology Bladder endometriosis hematuria dysuria bladder mass case report Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Endometriosis, a condition affecting approximately 10% of women in their reproductive years, is characterized by the presence of endometrial-like tissue outside the uterus. While commonly involving the ovaries or pelvic ligaments, endometriosis rarely affects the urinary tract, occurring in about 1% of cases. The bladder, particularly its posterior wall, is the most frequently involved site [1, 2]. The exact cause of endometriosis remains unknown, but theories include retrograde menstruation and the spread of endometrial cells via the blood or lymphatic system try to explain it [1]. Women with urinary tract endometriosis may experience a variety of symptoms, including pelvic pain, dyspareunia, urinary urgency and frequency, dysuria, and hematuria, particularly during menstruation [3]. This report presents a case of bladder endometriosis with undirected manifestations and investigations, highlighting the importance of considering this condition in women presenting with urological and gynecological symptoms. Case presentation Case history and examination: A 37-year-old Syrian woman presented to the clinic with urinary hesitancy, dysuria, suprapubic pain, and intermittent hematuria for a year, the patient has experienced dysmenorrhea, irregular menstruation, dyspareunia, and pelvic pain for three years until now. According to the patient, these symptoms did not follow a specific pattern related to menstruation. Her medical history showed a urinary tract infection one year prior, that did not respond to treatment, left lower extremity venous thrombosis seven years ago, and she was taking warfarin until now. Her surgical history included a laparoscopy for infertility due to adhesions 7 years prior and a cesarean section 5 years prior (after intracytoplasmic sperm injection). Her drugs (except warfarin), familial, and psychosocial histories were unremarkable. Differential Diagnosis, investigations, and treatment: The laboratory findings included hematuria on urinalysis (red blood cells filling the microscopic field), and an International Normalized Ratio of 2.5, other investigations, including Complete blood count, kidney function tests, and liver function tests were within normal. The ultrasound (US) imaging showed a mass on the posterior wall of the bladder, other findings were within normal. The computed tomography (CT) imaging revealed a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder (Fig. 1 ). A 5 cm functional cyst, likely benign, was also noted in the left ovary (Fig. 2 ). Pelvic magnetic resonance imaging (MRI) was performed using sagittal, coronal, and axial planes, both pre-and post-contrast injection. Imaging showed scarring from the previous cesarean section on the lower anterior uterine wall with associated uterine wall thinning. There was thickening of the posterior bladder wall with low signal on T2 (Fig. 3 ). Several small, high-signal T2 cystic spaces measuring approximately 23 x 16 mm demonstrated significant contrast enhancement. Enlargement of the posterior uterine wall near the cervix was noted, but no distinct masses were identified within the uterus. The ovaries appeared normal in size. Many differential diagnoses were made such as uterine mass (fibroid or neoplasm), bladder neoplasm, bladder endometriosis, foreign body, and sarcoma. The surgical approach was indicated to excise the mass and know its nature. The patient's written consent and medical consultations were taken before the surgery and they showed no contraindications. During the surgical procedure which was done by a specialist in urology, a Pfannenstiel incision was utilized, providing surgical access to the pelvic cavity. A solid mass was found on the posterior wall of the bladder, it was totally excised (Fig. 4 ). Outcome and follow-up: The patient was discharged from the hospital after two days in a good situation and without complications. The histopathological examination of the excised masse revealed benign endometriosis. The patient's manifestations were resolved after the surgery. Evaluations at 3 and 6 months post-surgery by cystoscopy were normal. She was followed for two years postoperatively without any recurrence. Discussion Endometriosis is defined as the presence of functional glands and stroma of the uterus outside its cavity [1, 2]. It affects 10–20% of women of reproductive age, especially between 30 and 45 years [3, 4]. It can form in different parts of the body, but the most affected locations are ovaries, ovarian fossa, pouch of Douglas, uterosacral ligaments, and rectovaginal septum [1]. The involvement of the urinary tract is rare (1% of all cases) [1, 2]. The most affected location of the urinary tract is the bladder (84%) [5, 6]. Bladder endometriosis can be classified into primary (happen spontaneously), and secondary (iatrogenic, which can form after pelvis surgery) [1, 3, 6]. Many theories try to explain endometriosis such as Implantation theory, Celomic theory, lymphatic or hematogenous dissemination, inflammatory disease, Endometriomas, and many others [1, 7]. The main symptoms of endometriosis are pain-related ones and infertility [2]. The manifestations of bladder endometriosis, which vary a lot depending on the size and location, include suprapubic and back pain, hematuria, irritative voiding symptoms related to menstruation, dysmenorrhea, and dyspareunia [1, 6]. 60% of patients with bladder endometriosis experience symptoms without any relationship to menstruation, as in our case [4]. For diagnosing this disease, we depend on anamnesis, pelvic examination (we can see uterine retroversion or painful uterine mobilization), radiological investigations, and laparoscopy. No serum marker can help us. Radiological investigations are essential. US imaging is a good method (sensitivity 83% and specificity 89%) [7]. It is suggested to do it either before or during menstruation because the lesions become clearer [5]. US imaging is less helpful in cases of deeply infiltrated endometriosis such as the bladder [7]. MRI is more helpful in such cases (its accuracy is about 98%). In addition, it helps determine the extent and severity of the disease [1, 7]. Laparoscopy is the golden standard in the diagnosis of endometriosis, where we can take biopsies that confirm the histopathological nature of the lesion [2, 7]. Many differential diagnoses should be kept in mind in addition to endometriosis including subserosal anterior leiomyoma, bladder cancer, interstitial cystitis, and cystitis [4, 8]. The management of the disease depends on medications and surgery. Drugs work by decreasing the estradiol levels in the serum, inhibiting ovulation, and reducing the blood flow in the uterus. They include Danazol (it is not recommended recently), oral contraceptives, GnRH agonists, GnRH antagonists (elagolix), and hormonal receptor modulators (such as ulipristal). Laparoscopy, in addition to its important role in diagnosis, is a cornerstone method in treatment. It allows for excising all the lesions (including peritoneal ones of all types), excising endometriomas, and lysis of the adhesions. When the lesions infiltrate the bladder, they must be removed even when we need to open and stature the bladder, and attention should be given to the ureteral mouth involvement [7]. Bladder endometriosis can also be treated by transurethral resection and segmental bladder resection [6]. Conclusion Bladder endometriosis should be kept in mind as a differential diagnosis of bladder masses despite its rarity because this condition is connected with many symptoms that affect the patient's quality of life and can cause infertility. Further studies are needed to understand the pathology of these lesions. Abbreviations Ultrasound (US) The computed tomography (CT) Magnetic resonance imaging (MRI) Declarations Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images and videos. A copy of the written consent is available for review by the editor of this journal. Ethics approval and consent to participate Not applicable. Competing interests No conflict of interest. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. Funding Not applicable. Acknowledgment We hope to thank SMSR Team Lab. for their efforts and bringing our team together. References Kho Lily 1, Goh CL, Lim C (2020) Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections. J Med Cases 11(11):370–373. 10.14740/jmc3543 Epub 2020 Sep 23. PMID: 34434349; PMCID: PMC8383495 Hakeem 2, Anwar A, Anwar SS, Fatima SS, Ahmed F (2021) Bladder Endometriosis Masquerading as Bladder Tumor: The Role of Magnetic Resonance Imaging in Diagnosis. Cureus 13(7):e16133. 10.7759/cureus.16133 PMID: 34354879; PMCID: PMC8327303 Xu MC, Yunker AC, Kaufman MR (2020) Conservative management of bladder endometriosis with acute renal failure. Urol Case Rep 33:101263. 10.1016/j.eucr.2020.101263 PMID: 32489896; PMCID: PMC7260429 Silva 4:BeatySD, De Petris AC (2015) Bladder Endometriosis: Ultrasound and MRI Findings. Radiol Case Rep 1(3):92–95. 10.2484/rcr.v1i3.16 PMID: 27298692; PMCID: PMC4891555 Bhatnagar 5:GuptaA, Seth A, Dang BN, Gupta A (2016) Bladder Endometriosis Mimicking TCC - A Case Report. J Clin Diagn Res 10(2):PD12–PD13. 10.7860/JCDR/2016/17488.7213 Epub 2016 Feb 1. PMID: 27042525; PMCID: PMC4800591 Mundhra 6:BahadurA, Sherwani R, Kumar P (2021) Robot-assisted partial cystectomy for bladder endometriosis: dual approach involving cystoscopy and robotic surgery. BMJ Case Rep 14(8):e244342. 10.1136/bcr-2021-244342 PMID: 34429296; PMCID: PMC8386226 Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Res. 2019;8:F1000 Faculty Rev-529. Published 2019 Apr 23. 10.12688/f1000research.14817.1 Pang ST, Chao A, Wang CJ, Lin G, Lee CL (2008) Transurethral partial cystectomy and laparoscopic reconstruction for the management of bladder endometriosis. Fertil Steril Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5939086","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":409744081,"identity":"0b1beea3-f565-4e51-a416-d367029c0139","order_by":0,"name":"Ahmad Alhamid","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDCCAxAqAYgNH374YQOkGRsPENDC2ADVYmws2ZMG0tJAtBYzCR62w8hWYwd8x5ufP/i4xy5Pt/3wNgkJnvN2a9sPA22psYnGpUXyzDHDxhnPkovNzqQVWxRY3E7ediYRqOVYWm4DDi0GN3IYm3kOMCduO5BjeEOC53ay2QGgFsaGw4S01CduO//GAOiXc8lm5x8SpeVw4rYbOUZALQfszG4QsAXkl5kzDhwHanlWDAzk5ASzG0BbEvD4BRhiDz58OFANdFjyRmBU2tmbnU9/+OBDjQ1OLRggEawygVjlIGBPiuJRMApGwSgYGQAAq11v0scleroAAAAASUVORK5CYII=","orcid":"","institution":"Al Hawash Private University","correspondingAuthor":true,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Alhamid","suffix":""}],"badges":[],"createdAt":"2025-01-31 23:05:50","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5939086/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5939086/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75604584,"identity":"c9715d86-5195-40ce-9332-3848a405b7f8","added_by":"auto","created_at":"2025-02-06 09:23:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178671,"visible":true,"origin":"","legend":"\u003cp\u003eCT imaging reveals a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder.\u0026nbsp;\u003c/p\u003e","description":"","filename":"Screenshotcn.wps.xiaomi.abroad.liteedit.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5939086/v1/6130f864eb27cfe75d9066ad.jpg"},{"id":75605910,"identity":"d6fde08f-c7a3-48c4-9715-706da56485ce","added_by":"auto","created_at":"2025-02-06 09:31:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104803,"visible":true,"origin":"","legend":"\u003cp\u003eCT imaging reveals a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder.\u0026nbsp;\u003c/p\u003e","description":"","filename":"Screenshotcn.wps.xiaomi.abroad.liteedit.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5939086/v1/d95d7e58a54bbdf8c18dd80d.jpg"},{"id":75604592,"identity":"9c31e0a2-ddb8-485d-b80c-3b49386784fa","added_by":"auto","created_at":"2025-02-06 09:23:09","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":124934,"visible":true,"origin":"","legend":"\u003cp\u003ePelvic MRI reveals scarring from the previous cesarean section on the lower anterior uterine wall with associated uterine wall thinning. There is thickening of the posterior bladder wall with low signal on T2-weighted imaging.\u003c/p\u003e","description":"","filename":"Screenshotcn.wps.xiaomi.abroad.liteedit.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5939086/v1/4c22f164b92a7c0d5f2d4b79.jpg"},{"id":75604583,"identity":"5918ba1e-1f76-49c0-808d-74f4fe6e8486","added_by":"auto","created_at":"2025-02-06 09:23:00","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":176110,"visible":true,"origin":"","legend":"\u003cp\u003eThis picture shows a surgical view after the excision of the endometriosis mass and its relation to the bladder trigone.\u003c/p\u003e","description":"","filename":"Screenshotcn.wps.xiaomi.abroad.liteedit.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5939086/v1/1df81644723f565c755c93e5.jpg"},{"id":75605913,"identity":"abeef10c-cf4a-4c66-969c-7cb4d99b4d06","added_by":"auto","created_at":"2025-02-06 09:31:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":819397,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5939086/v1/8af6990c-e487-4ee4-8fb5-a7c252b30d1a.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eBladder endometriosis in a patient with undirected manifestations, a rare case report.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis, a condition affecting approximately 10% of women in their reproductive years, is characterized by the presence of endometrial-like tissue outside the uterus. While commonly involving the ovaries or pelvic ligaments, endometriosis rarely affects the urinary tract, occurring in about 1% of cases. The bladder, particularly its posterior wall, is the most frequently involved site [1, 2]. The exact cause of endometriosis remains unknown, but theories include retrograde menstruation and the spread of endometrial cells via the blood or lymphatic system try to explain it [1]. Women with urinary tract endometriosis may experience a variety of symptoms, including pelvic pain, dyspareunia, urinary urgency and frequency, dysuria, and hematuria, particularly during menstruation [3]. This report presents a case of bladder endometriosis with undirected manifestations and investigations, highlighting the importance of considering this condition in women presenting with urological and gynecological symptoms.\u003c/p\u003e "},{"header":"Case presentation","content":"\u003cp\u003eCase history and examination:\u003c/p\u003e\u003cp\u003eA 37-year-old Syrian woman presented to the clinic with urinary hesitancy, dysuria, suprapubic pain, and intermittent hematuria for a year, the patient has experienced dysmenorrhea, irregular menstruation, dyspareunia, and pelvic pain for three years until now. According to the patient, these symptoms did not follow a specific pattern related to menstruation. Her medical history showed a urinary tract infection one year prior, that did not respond to treatment, left lower extremity venous thrombosis seven years ago, and she was taking warfarin until now. Her surgical history included a laparoscopy for infertility due to adhesions 7 years prior and a cesarean section 5 years prior (after intracytoplasmic sperm injection). Her drugs (except warfarin), familial, and psychosocial histories were unremarkable.\u003c/p\u003e\u003cp\u003eDifferential Diagnosis, investigations, and treatment:\u003c/p\u003e\u003cp\u003eThe laboratory findings included hematuria on urinalysis (red blood cells filling the microscopic field), and an International Normalized Ratio of 2.5, other investigations, including Complete blood count, kidney function tests, and liver function tests were within normal. The ultrasound (US) imaging showed a mass on the posterior wall of the bladder, other findings were within normal. The computed tomography (CT) imaging revealed a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A 5 cm functional cyst, likely benign, was also noted in the left ovary (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Pelvic magnetic resonance imaging (MRI) was performed using sagittal, coronal, and axial planes, both pre-and post-contrast injection. Imaging showed scarring from the previous cesarean section on the lower anterior uterine wall with associated uterine wall thinning. There was thickening of the posterior bladder wall with low signal on T2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Several small, high-signal T2 cystic spaces measuring approximately 23 x 16 mm demonstrated significant contrast enhancement. Enlargement of the posterior uterine wall near the cervix was noted, but no distinct masses were identified within the uterus. The ovaries appeared normal in size. Many differential diagnoses were made such as uterine mass (fibroid or neoplasm), bladder neoplasm, bladder endometriosis, foreign body, and sarcoma. The surgical approach was indicated to excise the mass and know its nature. The patient's written consent and medical consultations were taken before the surgery and they showed no contraindications. During the surgical procedure which was done by a specialist in urology, a Pfannenstiel incision was utilized, providing surgical access to the pelvic cavity. A solid mass was found on the posterior wall of the bladder, it was totally excised (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOutcome and follow-up:\u003c/p\u003e\u003cp\u003eThe patient was discharged from the hospital after two days in a good situation and without complications. The histopathological examination of the excised masse revealed benign endometriosis. The patient's manifestations were resolved after the surgery. Evaluations at 3 and 6 months post-surgery by cystoscopy were normal. She was followed for two years postoperatively without any recurrence.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEndometriosis is defined as the presence of functional glands and stroma of the uterus outside its cavity [1, 2]. It affects 10\u0026ndash;20% of women of reproductive age, especially between 30 and 45 years [3, 4]. It can form in different parts of the body, but the most affected locations are ovaries, ovarian fossa, pouch of Douglas, uterosacral ligaments, and rectovaginal septum [1]. The involvement of the urinary tract is rare (1% of all cases) [1, 2]. The most affected location of the urinary tract is the bladder (84%) [5, 6]. Bladder endometriosis can be classified into primary (happen spontaneously), and secondary (iatrogenic, which can form after pelvis surgery) [1, 3, 6]. Many theories try to explain endometriosis such as Implantation theory, Celomic theory, lymphatic or hematogenous dissemination, inflammatory disease, Endometriomas, and many others [1, 7]. The main symptoms of endometriosis are pain-related ones and infertility [2]. The manifestations of bladder endometriosis, which vary a lot depending on the size and location, include suprapubic and back pain, hematuria, irritative voiding symptoms related to menstruation, dysmenorrhea, and dyspareunia [1, 6]. 60% of patients with bladder endometriosis experience symptoms without any relationship to menstruation, as in our case [4]. For diagnosing this disease, we depend on anamnesis, pelvic examination (we can see uterine retroversion or painful uterine mobilization), radiological investigations, and laparoscopy. No serum marker can help us. Radiological investigations are essential. US imaging is a good method (sensitivity 83% and specificity 89%) [7]. It is suggested to do it either before or during menstruation because the lesions become clearer [5]. US imaging is less helpful in cases of deeply infiltrated endometriosis such as the bladder [7]. MRI is more helpful in such cases (its accuracy is about 98%). In addition, it helps determine the extent and severity of the disease [1, 7]. Laparoscopy is the golden standard in the diagnosis of endometriosis, where we can take biopsies that confirm the histopathological nature of the lesion [2, 7]. Many differential diagnoses should be kept in mind in addition to endometriosis including subserosal anterior leiomyoma, bladder cancer, interstitial cystitis, and cystitis [4, 8]. The management of the disease depends on medications and surgery. Drugs work by decreasing the estradiol levels in the serum, inhibiting ovulation, and reducing the blood flow in the uterus. They include Danazol (it is not recommended recently), oral contraceptives, GnRH agonists, GnRH antagonists (elagolix), and hormonal receptor modulators (such as ulipristal). Laparoscopy, in addition to its important role in diagnosis, is a cornerstone method in treatment. It allows for excising all the lesions (including peritoneal ones of all types), excising endometriomas, and lysis of the adhesions. When the lesions infiltrate the bladder, they must be removed even when we need to open and stature the bladder, and attention should be given to the ureteral mouth involvement [7]. Bladder endometriosis can also be treated by transurethral resection and segmental bladder resection [6].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBladder endometriosis should be kept in mind as a differential diagnosis of bladder masses despite its rarity because this condition is connected with many symptoms that affect the patient's quality of life and can cause infertility. Further studies are needed to understand the pathology of these lesions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUltrasound (US)\u003c/p\u003e\n\u003cp\u003eThe computed tomography (CT)\u003c/p\u003e\n\u003cp\u003eMagnetic resonance imaging (MRI)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images and videos. A copy of the written consent is available for review by the editor of this journal.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eNo conflict of interest.\u003c/p\u003e\n\u003cp\u003eDATA AVAILABILITY STATEMENT\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAcknowledgment\u003c/p\u003e\n\u003cp\u003eWe hope to thank SMSR Team Lab. for their efforts and \u0026nbsp;bringing our team together.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKho Lily 1, Goh CL, Lim C (2020) Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections. J Med Cases 11(11):370\u0026ndash;373. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.14740/jmc3543\u003c/span\u003e\u003c/span\u003eEpub 2020 Sep 23. PMID: 34434349; PMCID: PMC8383495\u003c/li\u003e\n\u003cli\u003eHakeem 2, Anwar A, Anwar SS, Fatima SS, Ahmed F (2021) Bladder Endometriosis Masquerading as Bladder Tumor: The Role of Magnetic Resonance Imaging in Diagnosis. Cureus 13(7):e16133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.16133\u003c/span\u003e\u003c/span\u003ePMID: 34354879; PMCID: PMC8327303\u003c/li\u003e\n\u003cli\u003eXu MC, Yunker AC, Kaufman MR (2020) Conservative management of bladder endometriosis with acute renal failure. Urol Case Rep 33:101263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eucr.2020.101263\u003c/span\u003e\u003c/span\u003ePMID: 32489896; PMCID: PMC7260429\u003c/li\u003e\n\u003cli\u003eSilva 4:BeatySD, De Petris AC (2015) Bladder Endometriosis: Ultrasound and MRI Findings. Radiol Case Rep 1(3):92\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2484/rcr.v1i3.16\u003c/span\u003e\u003c/span\u003ePMID: 27298692; PMCID: PMC4891555\u003c/li\u003e\n\u003cli\u003eBhatnagar 5:GuptaA, Seth A, Dang BN, Gupta A (2016) Bladder Endometriosis Mimicking TCC - A Case Report. J Clin Diagn Res 10(2):PD12\u0026ndash;PD13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7860/JCDR/2016/17488.7213\u003c/span\u003e\u003c/span\u003eEpub 2016 Feb 1. PMID: 27042525; PMCID: PMC4800591\u003c/li\u003e\n\u003cli\u003eMundhra 6:BahadurA, Sherwani R, Kumar P (2021) Robot-assisted partial cystectomy for bladder endometriosis: dual approach involving cystoscopy and robotic surgery. BMJ Case Rep 14(8):e244342. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2021-244342\u003c/span\u003e\u003c/span\u003ePMID: 34429296; PMCID: PMC8386226\u003c/li\u003e\n\u003cli\u003eRolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Res. 2019;8:F1000 Faculty Rev-529. Published 2019 Apr 23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12688/f1000research.14817.1\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003ePang ST, Chao A, Wang CJ, Lin G, Lee CL (2008) Transurethral partial cystectomy and laparoscopic reconstruction for the management of bladder endometriosis. Fertil Steril\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bladder endometriosis, hematuria, dysuria, bladder mass, case report","lastPublishedDoi":"10.21203/rs.3.rs-5939086/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5939086/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eKey clinical message\u003c/p\u003e\n\u003cp\u003eEndometriosis is defined as the presence of functional glands and stroma of the uterus outside its cavity. It affects 10-20% of women of reproductive age. It can form in different body parts; the involvement of the urinary tract is rare (1% of all cases). We report here a case of a 37-year-old woman who presented to the clinic with urinary hesitancy, dysuria, suprapubic pain, and intermittent hematuria for a year, the patient experienced dysmenorrhea, irregular menstruation, dyspareunia, and pelvic pain from three years until now. According to the patient, these symptoms did not follow a specific pattern related to menstruation. The laboratory findings included hematuria and an International Normalized Ratio of 2.5, other investigations were within normal. The radiological investigations revealed a 3 cm mass on the posterior bladder wall extending towards the uterus, raising the possibility of a bladder mass or a uterine mass involving the bladder. \u0026nbsp;Many differential diagnoses were made such as uterine mass, bladder neoplasm, bladder endometriosis, foreign body, and sarcoma. The surgical approach was indicated to excise the mass and know its nature. A solid mass was found on the posterior wall of the bladder, it was excised. The patient was discharged from the hospital after two days in a good situation and without complications. The histopathological examination of the excised masse revealed benign endometriosis. She was followed for two years postoperatively without any recurrence.\u003c/p\u003e","manuscriptTitle":"Bladder endometriosis in a patient with undirected manifestations, a rare case report.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 09:22:55","doi":"10.21203/rs.3.rs-5939086/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"640a92df-ec47-48f6-836c-12ed7a7870b6","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":43696341,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2025-02-06T09:22:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-06 09:22:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5939086","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5939086","identity":"rs-5939086","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}