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.