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Total laparoscopic bladder resection in the management of deep endometriosis: “take it or leave it.” Radicality versus persistence

  • Marcello Ceccaroni
  • Roberto Clarizia
  • Matteo CeccarelloEmail author
  • Paola De Mitri
  • Giovanni Roviglione
  • Daniele Mautone
  • Giuseppe Caleffi
  • Alberto Molinari
  • Giacomo Ruffo
  • Stefano Cavalleri
Original Article

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.

Keywords

Bladder endometriosis Laparoscopic cystectomy Bladder suturing Deep-infiltrating endometriosis Segmental bowel resection 

Notes

Compliance with ethical standards

Conflicts of interest

None.

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Marcello Ceccaroni
    • 1
  • Roberto Clarizia
    • 1
  • Matteo Ceccarello
    • 1
    Email author
  • Paola De Mitri
    • 1
  • Giovanni Roviglione
    • 1
  • Daniele Mautone
    • 1
  • Giuseppe Caleffi
    • 2
  • Alberto Molinari
    • 2
  • Giacomo Ruffo
    • 3
  • Stefano Cavalleri
    • 2
  1. 1.Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical AnatomyIRCCS “Sacro Cuore-Don Calabria” HospitalVeronaItaly
  2. 2.Department of UrologyIRCCS “Sacro Cuore-Don Calabria” HospitalVeronaItaly
  3. 3.Department of General SurgeryIRCSS “Sacro Cuore-Don Calabria” HospitalVeronaItaly

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