Deep endometriosis inflicting the bladder: Long-term outcomes of surgical management

Objective: To assess the efficacy and safety of laparoscopic treatment of bladder endometriosis, especially in cases of full thickness endometriotic nodules. Design: Retrospective review of medical records. Setting: Tertiary medical center and a referral center for endometriosis. Population: Sixty-nine patients with bladder endometriosis that underwent surgery between January 2005 and December 2011. Methods: The records of all patients with bladder endometriosis were reviewed and the pre-, intra- and postoperative information of patients who underwent surgery was collected. Main outcome measures: Efficacy, safety and long-term outcome of laparoscopic treatment of bladder endometriosis. Results: The mean age of 69 patients with bladder endometriosis was 31.3 ± 4.6 years. Preoperative urinary symptoms (such as frequency, urgency, dysuria and others) were present in 28 (40.0 %) patients. Laparoscopy was performed in all patients. Deep detrusor involvement was found in 45 (65.2 %) patients. Of these, 21 patients underwent partial cystectomy due to a full thickness lesion. Deep nodule resection without bladder invasion was performed in 24 (34.8 %) patients and bladder nodule coagulation and ablation in the remaining 24 (34.8 %) patients with superficial involvement. No intraoperative complications were noted. Postoperative follow-up results were available for all patients. After a median (range) follow-up period of 60 (4-92) months, 92.7 % of the patients were asymptomatic or reported improvement in symptoms. Conclusions: After a long-term follow-up surgical management of bladder endometriosis is strongly recommended. During surgery, careful inspection and full excision of bladder lesions should be performed. Laparoscopic excision is a safe and efficacies approach.