Endometriosis of bladder: outcomes after laparoscopic surgery

STUDY OBJECTIVE: To describe outcomes after laparoscopic excision of deep bladder endometriosis. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University hospitals. PATIENTS: Twenty-one consecutive patients with endometriotic nodule on the bladder (infiltrating detrusor muscle) from a series of 169 patients were included in the study. The primary outcome studied was resolution of bladder symptoms. Secondary outcomes included complication rates, recurrence rates, and pregnancy rates after laparoscopic surgery. INTERVENTIONS: Laparoscopic excision of bladder endometriosis. MEASUREMENTS AND MAIN RESULTS: Laparoscopy was feasible in all cases without the need for conversion. Median follow-up was 20 months. Ten patients (47.6%) underwent partial cystectomy, and the remaining patients underwent partial-thickness excision of the detrusor muscle. Sixteen patients (76%) had associated deep lesions in the pelvis. The most common associated lesions were rectovaginal nodules (38%) and ureteric lesions (14%), with signs of obstruction. Major complications developed in 3 patients (14%), primarily related to bowel resection. Six patients became pregnant (60%). No patients experienced disease recurrence. CONCLUSION: Laparoscopic excision is feasible in all types of bladder endometriosis but often involves multiple procedures to manage associated lesions, especially rectovaginal nodules and ureteric lesions. Previous reports have suggested that ureteric lesions are not associated with bladder endometriosis; however, this was not true in our series. Complications are primarily related to severity of the disease and associated procedures. Partial cystectomy is not required in all cases to achieve adequate clearance. Complete excision of the disease is associated with resolution of bladder symptoms and low recurrence rates.