Genitourinary manifestations of endometriosis with emphasis on the urinary tract

  • 44 Accesses


Endometriosis is a common benign condition affecting women. The disease has a broad spectrum of presentations from incidental lesions in asymptomatic women to causing significant and debilitating morbidity in others. Ectopic endometrial glands are located in predictable locations throughout the pelvis, including implantation on the ovaries and in the rectouterine cul-de-sac. Less commonly, the urinary tract may be involved. As genitourinary manifestations may remain symptomatically occult or masquerade as other diagnoses, it is essential for the radiologist to be aware of the imaging features, consider this diagnosis, and potentially save the patient from delayed treatment.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10


  1. 1.

    Stovall, D.W., et al., Endometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril, 1997. 68(1): p. 13-8.

  2. 2.

    Guzick, D.S., et al., Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine’s revised classification of endometriosis. Fertil Steril, 1997. 67(5): p. 822-9.

  3. 3.

    Giudice, L.C. and L.C. Kao, Endometriosis. Lancet, 2004. 364(9447): p. 1789-99.

  4. 4.

    Carter, J.E., Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc, 1994. 2(1): p. 43-7.

  5. 5.

    Ling, F.W., Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol, 1999. 93(1): p. 51-8.

  6. 6.

    Practice bulletin no. 114: management of endometriosis. Obstet Gynecol, 2010. 116(1): p. 223-36.

  7. 7.

    Charatsi, D., et al., Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis. Adv Med, 2018. 2018: p. 3461209.

  8. 8.

    Chapron, C., et al., Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod, 2003. 18(1): p. 157-61.

  9. 9.

    Comiter, C.V., Endometriosis of the urinary tract. Urol Clin North Am, 2002. 29(3): p. 625-35.

  10. 10.

    Knabben, L., et al., Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril, 2015. 103(1): p. 147-52.

  11. 11.

    Darvishzadeh, A., et al., Deep pelvic endometriosis: a radiologist’s guide to key imaging features with clinical and histopathologic review. Abdom Radiol (NY), 2016. 41(12): p. 2380-2400.

  12. 12.

    Kolodziej, A., et al., Urinary Tract Endometriosis. Urol J, 2015. 12(4): p. 2213-7.

  13. 13.

    Sampson, J.A., Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal of Obstetrics & Gynecology, 1927. 14(4): p. 422-469.

  14. 14.

    Ferguson, B.R., J.L. Bennington, and S.L. Haber, Histochemistry of mucosubstances and histology of mixed mullerian pelvic lymph node glandular inclusions. Evidence for histogenesis by mullerian metaplasia of coelomic epithelium. Obstet Gynecol, 1969. 33(5): p. 617-25.

  15. 15.

    Sasson, I.E. and H.S. Taylor, Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci, 2008. 1127: p. 106-15.

  16. 16.

    Sampson, J.A., Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol, 1927. 3(2): p. 93-110 43.

  17. 17.

    Chamie, L.P., et al., Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings. Radiographics, 2018. 38(1): p. 309-328.

  18. 18.

    Jensen, J.R. and C.C. Coddington, 3rd, Evolving spectrum: the pathogenesis of endometriosis. Clin Obstet Gynecol, 2010. 53(2): p. 379-88.

  19. 19.

    Anglesio, M.S., et al., Cancer-Associated Mutations in Endometriosis without Cancer. N Engl J Med, 2017. 376(19): p. 1835-1848.

  20. 20.

    Bulun, S.E., Endometriosis. N Engl J Med, 2009. 360(3): p. 268-79.

  21. 21.

    Burney, R.O. and L.C. Giudice, Pathogenesis and pathophysiology of endometriosis. Fertil Steril, 2012. 98(3): p. 511-9.

  22. 22.

    Piketty, M., et al., Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod, 2009. 24(3): p. 602-7.

  23. 23.

    Bazot, M., et al., European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol, 2017. 27(7): p. 2765-2775.

  24. 24.

    Chamie, L.P., et al., Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics, 2011. 31(4): p. E77-100.

  25. 25.

    Brosens, I.A., P.J. Puttemans, and J. Deprest, The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril, 1994. 61(6): p. 1034-8.

  26. 26.

    Brosens, I., et al., Diagnosis of endometriosis: pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol, 2004. 18(2): p. 285-303.

  27. 27.

    Patel, M.D., et al., Endometriomas: diagnostic performance of US. Radiology, 1999. 210(3): p. 739-45.

  28. 28.

    Robinson, K.A., et al., Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol (NY), 2019.

  29. 29.

    Giudice, L.C., Clinical practice. Endometriosis. N Engl J Med, 2010. 362(25): p. 2389-98.

  30. 30.

    Koninckx, P.R., et al., Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril, 1991. 55(4): p. 759-65.

  31. 31.

    Anaf, V., et al., Smooth muscles are frequent components of endometriotic lesions. Hum Reprod, 2000. 15(4): p. 767-71.

  32. 32.

    Wang, G., et al., Rich innervation of deep infiltrating endometriosis. Hum Reprod, 2009. 24(4): p. 827-34.

  33. 33.

    Bazot, M., et al., Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril, 2009. 92(6): p. 1825-33.

  34. 34.

    Maccagnano, C., et al., Diagnosis and treatment of bladder endometriosis: state of the art. Urol Int, 2012. 89(3): p. 249-58.

  35. 35.

    Siegelman, E.S. and E.R. Oliver, MR imaging of endometriosis: ten imaging pearls. Radiographics, 2012. 32(6): p. 1675-91.

  36. 36.

    Vercellini, P., et al., The pathogenesis of bladder detrusor endometriosis. Am J Obstet Gynecol, 2002. 187(3): p. 538-42.

  37. 37.

    Berlanda, N., et al., Ureteral and vesical endometriosis. Two different clinical entities sharing the same pathogenesis. Obstet Gynecol Surv, 2009. 64(12): p. 830-42.

  38. 38.

    Abrao, M.S., et al., Endometriosis of the ureter and bladder are not associated diseases. Fertil Steril, 2009. 91(5): p. 1662-7.

  39. 39.

    Fedele, L., et al., Pre-operative assessment of bladder endometriosis. Hum Reprod, 1997. 12(11): p. 2519-22.

  40. 40.

    Seracchioli, R., et al., Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series. Hum Reprod, 2015. 30(4): p. 833-9.

  41. 41.

    Stanley, K.E., Jr., D.C. Utz, and M.B. Dockerty, Clinically Significant Endometriosis of the Urinary Tract. Surg Gynecol Obstet, 1965. 120: p. 491-8.

  42. 42.

    Saavalainen, L., et al., Deep infiltrating endometriosis affecting the urinary tract-surgical treatment and fertility outcomes in 2004-2013. Gynecol Surg, 2016. 13(4): p. 435-444.

  43. 43.

    Holland, T.K., et al., Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol, 2010. 36(2): p. 241-8.

  44. 44.

    Marshall, V.F., The occurrence of endometrial tissue in the kidney. Case report and discussion. The Journal of Urology, 1943. 50(6): p. 652-656.

  45. 45.

    Giambelluca, D., et al., Renal endometriosis mimicking complicated cysts of kidney: report of two cases. G Chir, 2017. 38(5): p. 250-255.

  46. 46.

    Yang, J., et al., Renal endometriosis tends to be misdiagnosed as renal tumor: a rare case report. Int Surg, 2015. 100(2): p. 376-80.

  47. 47.

    Coutinho, A., Jr., et al., MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics, 2011. 31(2): p. 549-67.

  48. 48.

    Chowdhry, A.A., F.H. Miller, and R.A. Hammer, Endometriosis presenting as a urethral diverticulum: a case report. J Reprod Med, 2004. 49(4): p. 321-3.

  49. 49.

    Honore, G.M., Extrapelvic endometriosis. Clin Obstet Gynecol, 1999. 42(3): p. 699-711.

  50. 50.

    Baker, P.M., et al., Superficial endometriosis of the uterine cervix: a report of 20 cases of a process that may be confused with endocervical glandular dysplasia or adenocarcinoma in situ. Int J Gynecol Pathol, 1999. 18(3): p. 198-205.

  51. 51.

    Gardner, H.L., Cervical and vaginal endometriosis. Clin Obstet Gynecol, 1966. 9(2): p. 358-72.

  52. 52.

    Foti, P.V., et al., Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging, 2018. 9(2): p. 149-172.

  53. 53.

    Medeiros, L.R., et al., Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet, 2015. 291(3): p. 611-21.

Download references

Author information

Correspondence to C. Bolan.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Agely, A., Bolan, C., Metcalfe, A. et al. Genitourinary manifestations of endometriosis with emphasis on the urinary tract. Abdom Radiol (2020) doi:10.1007/s00261-019-02383-8

Download citation


  • Endometriosis
  • Genitourinary
  • Urogenital
  • Ureteral
  • Bladder