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CASE REPORT
Year : 2003  |  Volume : 19  |  Issue : 2  |  Page : 160-161
 

Vesical endometriosis: A case report


Urology Unit, Department of Surgery, Bankura Sammilani Medical College, Bankura, India

Correspondence Address:
Dilip Kumar Pal
A-30, Govt. Housing Estate, Govindanagar, Side-B, Bankura - 722102
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Urinary Bladder, endometriosis.


How to cite this article:
Pal DK. Vesical endometriosis: A case report. Indian J Urol 2003;19:160-1

How to cite this URL:
Pal DK. Vesical endometriosis: A case report. Indian J Urol [serial online] 2003 [cited 2019 Jul 16];19:160-1. Available from: http://www.indianjurol.com/text.asp?2003/19/2/160/37151



   Case Report Top


A 38-year-old woman, para 0+2 presented with haema­turia for 3 days. She had a similar episode of haematuria 1 month back. On clinical examination she did not have any apparent abnormality.

Her urinalysis was normal except plenty of RBCs. Urine culture showed no growth. Serum haemoglobin and renal bio-chemical parameters were within normal limits. Ul­trasonography suggested an endoluminal growth in the posterior wall of the bladder [Figure - 1]. Cyctoscopy suggested a lx1 cm sessile mass in the posterior bladder wall with surrounding congestion. Transurethral resection was done taking it as a bladder tumour. Histology suggested a midproliferative endometrial tissue [Figure - 2]. Then thorough search for endometriosis in other pelvic organs was made by per speculum examination, bimanual examination and diagnostic laparoscopy which revealed a normal size uterus, tubes, ovaries, pelvic peritoneum, cul-de-sac and uterosacral ligaments. In the postoperative period patient was given danazole 400 mg daily for 6 months. At 2years' of follow-up the patient was having normal mensuration with no recurrence.


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Endometriosis is a common disease in child bearing age where endometrial tissue is deposited outside the uterine cavity. [1] Most commonly it affects organs like ovaries, uterine ligaments,  Fallopian tube More Detailss, rectum and cervico-vagi­nal regions. Involvement of urinary tract is rare (1-2%) [1],[2] and urinary bladder is the most frequently involved or­gan. [1],[3] The classical presentations are cyclical urgency, frequency, suprapubic pain with or without haematuria and dyspareunia. [2] Endometriosis should be suspected with such presentation with no documented infection in child-bear­ing age. Ultrasonography, specially endovaginal sono­graphy is more sensitive for diagnosis than CT or MRI. [2],[3] Cystoscopy and biopsy gives the definite diagnosis. Urog­raphy, though nonspecific, is still useful to evaluate the integrity of upper urinary tracts [3] specially in disseminated cases. Though both surgical and medical management is advocated, surgical extirpation is more effective. [1] Exci­sion of endometrioma followed by Gn-RH analogue is the preferred treatment, particularly in young patients where fertility should be preserved. Apart from traditional sur­gery, laparoscopic partial cystectomy is a better choice if the surgeon is experienced enough and it does not require ureteric transplantation. [4],[5] Transurethral resection of vesi­cal endometrial tissue may be a valid therapeutic option as in this case.

 
   References Top

1.Westney OL. Amundsen CL, McGuire EJ. Bladder endometriosis: Conservative management. J Urol 2000; 163: 1814-1817.  Back to cited text no. 1    
2.Savoca G. Trombetta C, Troiano L. Guaschino S, Raber M, Bel l -rano E. Ecographic. MRI and CT features in a case of bladder endome­triosis. Arch Ital Urol Androl 1996: 68: 193-196.  Back to cited text no. 2    
3.Fedel L. Bianchi S. Raffaelli R, Portuese A. Preoperative assess­ment of bladder endometriosis. Hum Reprod 1997; 12: 2519-2522.  Back to cited text no. 3    
4.Chapron C. Dubuisson JB, Jacob S. Fauconnieer A, Da Costa VM. Laparoscopy and bladder endometriosis. Gynecol Obstet Fertil 2000; 28: 232-237.  Back to cited text no. 4    
5.Chapron C. Dubuisson JB. Laparoscopic management of bladder endometriosis. Acta Obstet Gynecol Scand 1999: 78: 887-890.  Back to cited text no. 5    


    Figures

  [Figure - 1], [Figure - 2]



 

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