Endometriosis of the Bladder

Zübeyde Yıldırım Ekin

doi:10.4274/jus.2016.993

Endometriosis of the Bladder

Zübeyde Yıldırım Ekin

In: Journal of Urological Surgery · 2016 · vol. 3(2) , pp. 64–65 · doi:10.4274/jus.2016.993 · W2440293149

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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This paper describes bladder endometriosis, an uncommon condition affecting the urinary tract, detailing its primary and secondary forms, common symptoms, diagnostic findings, and microscopic features.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper describes bladder endometriosis, a rare urinary tract involvement occurring in about 1% of endometriosis cases, with roughly two clinical forms: primary disease without prior uterine surgery and secondary disease after pelvic operations. It outlines typical symptom patterns (hematuria, dysuria, urgency, with about half of patients asymptomatic), common cystoscopic appearance, and key microscopic diagnostic criteria requiring identification of at least two of endometrial glands, endometrial stromal cells, and evidence of hemorrhage. The article also notes differential diagnosis issues, including symptom overlap with interstitial cystitis and the need to distinguish from primary invasive bladder adenocarcinoma, while acknowledging that processes such as Arias-Stella reaction, endometrial hyperplasia, and malignant transformation may be seen. This paper is centrally about endometriosis — specifically endometriosis involving the bladder.

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Abstract

Endometriosis is characterized by the presence of functional endometrial tissue outside the uterus. Endometriosis is common entity, but the involvement of the urinary tract is rare (1). Although endometriosis frequently occurs in women of reproductive age, bladder endometriosis is an uncommon condition (approximately 1% of all endometriosis cases). On the other hand, the bladder is the most affected organ in the urinary tract (2). Two forms of bladder endometriosis have been defined: One occurs in women without a history of uterine surgery (primary), and the other one develops after pelvic operation (iatrogenic or secondary) (3). The average age of cases is approximately 35 years. Frequency, hematuria, dysuria and urgency are the most common symptoms, however, approximately 50% of patients are asymptomatic. Severity of symptoms is related to the size of endometriotic lesions and the location. Endometriosis of the muscularis propria may show similar symptoms to those of interstitial cystitis. There is a palpable suprapubic mass in almost 50% of cases, and it may undergo catamenial expansion. Therefore, it must be kept in mind in the differential diagnosis of hematuria especially in female patients in the reproductive age (4,5). Rarely, endometriosis has been described in postmenopausal female patients treated with estrogen, likewise in men treated with hormone therapy for prostate cancer (5). Cystoscopic examination of endometriosis reveals edematous, erythematous mucosal elevations overlying blue-black or red-blue cysts, a grossly hemorrhagic, ill-defined, polypoid lesion. The overlying urothelium sometimes may be eroded. If the lesions are located in the muscularis propria or serosa, the mucosa may be intact. The bladder wall around the lesion may be thickened because of hyperplasia and fibrosis (1). Microscopically, the lesion is consisted of endometrial glands and stroma which is identical endometriosis as seen elsewhere (Figure 1). The diagnosis depends on identification Tepecik Training and Research Hospital, Clinic of Pathology, Izmir Turkey Mesanenin Endometriozisi