Endometriosis is a disease characterized by tissue resembling the endometrium, or the lining of the uterus, growing outside the uterus. These implants, or lesions, respond to the same hormone cycle that controls menstruation, swelling and shedding in a cyclical manner.
However, since they are located outside the uterus, they cannot be expelled properly, leading to inflammation and pain. It can also result in fibrosis, or the development of scar tissue, around the implants, which can cause organs to “stick” together.
Endometrial lesions can occur beneath the uterus, in the abdominal wall, or less often, in the bowel or bladder.
Evidence for bladder endometriosis
Endometriosis of the bladder can be superficial where the endometrial lesions are located on the outside of the bladder wall, or they can be within the wall of the bladder in nodules, which can obstruct the ureters — the tubes that carry urine from the kidneys to the bladder. Either location may make urination painful or difficult, especially during menstruation, when the endometrial lesions are enlarged and shedding.
Some patients also report having overactive bladders and a feeling of urgency regardless of how recently they have urinated.
Endometriosis in the bladder should not affect fertility; however, bladder lesions are often associated with severe endometriosis with many deep implants, which can affect fertility.
Treatment for endometriosis of the bladder
Hormone treatments to reduce pain and inflammation can also help reduce the symptoms of bladder endometriosis. However, a more drastic treatment option is the surgical removal of the endometrial lesions or cysts. If the ureters are affected, it may be necessary to remove the piece of the ureter containing the lesion and reconnect the ureter ends. Depending on the size and location of the endometrial lesions, the surgery would be either a laparotomy or laparoscopy.
Endometriosis can sometimes return after surgery, but this seems to be less likely if hormonal therapy is used following surgery. A retrospective study published in Urologia Internationalis examined published records of patients with deep pelvic endometriosis stage 3 or 4. The bladder was implicated in 85% of cases. Surgical resection alone resulted in a 35% reoccurrence of endometriosis. Surgery combined with hormone treatment had a 30% reoccurrence rate.
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