Marcello Ceccaroni1, Roberto Clarizia1, Matteo Ceccarello2, Paola De Mitri1, Giovanni Roviglione1, Daniele Mautone1, Giuseppe Caleffi3, Alberto Molinari3, Giacomo Ruffo4, Stefano Cavalleri3. 1. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar di Valpolicella, Verona, Italy. 2. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar di Valpolicella, Verona, Italy. matteo.ceccarello@sacrocuore.it. 3. Department of Urology, IRCCS "Sacro Cuore-Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy. 4. Department of General Surgery, IRCSS "Sacro Cuore-Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy.
Abstract
BACKGROUND: Bladder endometriosis (BE) is the most common external site of deep-infiltrating endometriosis (DIE) affecting the urinary tract. Frequently associated with other DIE lesions, it can be strongly related to a ventral spread of adenomyosis. Possible symptoms are urinary frequency, tenesmus and hematuria, and they are frequently related to DIE of the posterior and lateral compartment. Hormonal therapy can be used in non-symptomatic patients; conversely, in other cases surgical treatment is the management of choice. METHODS: Retrospective cohort study of a series of consecutive patients treated between September 2004 and December 2017 in a tertiary care referral center. Only full-thickness detrusor involvement was considered as BE. All patients underwent laparoscopic bladder resection with concomitant radical excision of DIE. RESULTS: BE was found in 264 patients and was associated with simultaneous bowel DIE requiring bowel resection in 140 patients (53%). Twenty-five patients (9.5%) had associated obstructive ureteral signs requiring ureteroneocystostomy. Mean hospital stay and time of catheter removal were 9.7 and 9.1 days, respectively. Postoperative major complications (< 28 days) were observed in 19 patients (7.2%). Follow-up was performed at 1, 6 and 12 months after surgery, with a 2.3% recurrence rate observed. CONCLUSIONS: Laparoscopic partial cystectomy for BE is a feasible and safe technique, and experienced laparoscopic surgeons should consider it the gold standard treatment. Surgical eradication leads to excellent surgical outcomes in terms of reduction of symptoms and recurrence rates, considering the need to maintain an adenomyotic uterus for fertility purposes.
BACKGROUND:Bladder endometriosis (BE) is the most common external site of deep-infiltrating endometriosis (DIE) affecting the urinary tract. Frequently associated with other DIE lesions, it can be strongly related to a ventral spread of adenomyosis. Possible symptoms are urinary frequency, tenesmus and hematuria, and they are frequently related to DIE of the posterior and lateral compartment. Hormonal therapy can be used in non-symptomatic patients; conversely, in other cases surgical treatment is the management of choice. METHODS: Retrospective cohort study of a series of consecutive patients treated between September 2004 and December 2017 in a tertiary care referral center. Only full-thickness detrusor involvement was considered as BE. All patients underwent laparoscopic bladder resection with concomitant radical excision of DIE. RESULTS: BE was found in 264 patients and was associated with simultaneous bowel DIE requiring bowel resection in 140 patients (53%). Twenty-five patients (9.5%) had associated obstructive ureteral signs requiring ureteroneocystostomy. Mean hospital stay and time of catheter removal were 9.7 and 9.1 days, respectively. Postoperative major complications (< 28 days) were observed in 19 patients (7.2%). Follow-up was performed at 1, 6 and 12 months after surgery, with a 2.3% recurrence rate observed. CONCLUSIONS: Laparoscopic partial cystectomy for BE is a feasible and safe technique, and experienced laparoscopic surgeons should consider it the gold standard treatment. Surgical eradication leads to excellent surgical outcomes in terms of reduction of symptoms and recurrence rates, considering the need to maintain an adenomyotic uterus for fertility purposes.
Authors: Stefanie Burghaus; Sebastian D Schäfer; Matthias W Beckmann; Iris Brandes; Christian Brünahl; Radek Chvatal; Jan Drahoňovský; Wojciech Dudek; Andreas D Ebert; Christine Fahlbusch; Tanja Fehm; Peter Martin Fehr; Carolin C Hack; Winfried Häuser; Katharina Hancke; Volker Heinecke; Lars-Christian Horn; Christian Houbois; Christine Klapp; Heike Kramer; Harald Krentel; Jan Langrehr; Heike Matuschewski; Ines Mayer; Sylvia Mechsner; Andreas Müller; Armelle Müller; Michael Müller; Peter Oppelt; Thomas Papathemelis; Stefan P Renner; Dietmar Schmidt; Andreas Schüring; Karl-Werner Schweppe; Beata Seeber; Friederike Siedentopf; Horia Sirbu; Daniela Soeffge; Kerstin Weidner; Isabella Zraik; Uwe Andreas Ulrich Journal: Geburtshilfe Frauenheilkd Date: 2021-04-14 Impact factor: 2.915