Bladder detrusor endometriosis: Clinical and pathogenetic implications

Purpose: We examined the pathogenesis of vesical endometriosis, identified the diagnostic signs and defined a successful management strategy. Materials and Methods: The records of 8 patients with bladder detrusor endometriosis were reviewed. Results: Two distinct forms of the condition appear to exist, that is spontaneous and postcesarean. In the former case the bladder lesion is a manifestation of a generalized pelvic disease, whereas after iatrogenic dissemination growth of ectopic endometrium is usually limited to the bladder wall. The catamenial nature of bladder symptoms (frequency, urgency, dysuria and tenesmus) was pathognomonic. Cystoscopy with biopsy was diagnostic in 3 cases. Ultrasonography revealed an endo-luminal vegetation and ruled out an anterior uterine leiomyoma, whereas magnetic resonance imaging did not add relevant information. Partial cystectomy appears to cure the urinary disturbances. Conclusions: We suggest a high index of suspicion of vesical endometriosis in all premenopausal women complaining of catamenial bladder symptoms with negative urine cultures.