A rare case of urinary bladder endometriosis along with ureteric and ureterovesical junction involvement following cesarean section

Urinary tract endometriosis is a rare condition involving 1% of woman having pelvic endometriosis with predominantly urinary bladder involvement (84%). We report a case of urinary bladder endometriosis presenting as a polypoidal tumor in the left posterolateral wall of the urinary bladder base and left ureteo-vesical junction and left lower ureter. A 25 year old woman with history of two LSCS, presented with chief complaints of severe dysuria, burning micturition, suprapubic pain and left sided flank pain. In Ultrasound and CT Urography there was severe hydronephrosis of left kidney with marked cortical thinning and approx 10×17 mm soft tissue density mass near left uretrovesical junction causing obstruction to left uretric opening leading to left uretric dilatation. Cystoscopy showed 0.3x0.5 cm polypoidal, reddish blue coloured lesion around area of left uretric opening. Transurethral resection of polypoidal lesion was done and HPE showed features of papillary cystitis. Follow up shows recurrence of the mass at same place with mildly asymmetric mural thickening of the posterolateral wall of bladder base and VUJ with grossly hydronephrotic left kidney showing parenchymal thinning and delayed and reduced excretion of contrast in collecting system in CT urography. Exploration followed by complete excision of the mass from the left lower ureter and urinary bladder with left ureteroneocystostomy was done.Histopathological examination of excised mass was suggestive of endometriosis. Subsequently she was put on hormonal therapy on which she is doing well. Clinicians should suspect urinary tract endometriosis in woman in reproductive age group, presenting with urinary symptoms, especially following Cesarean section.Thorough history, physical examination, and imaging can potentially help in the diagnosis. Main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.