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

• Published in: International Urogynecology Journal 2020-08, Vol.31 (8), p.1683-1690
• Main Authors: Ceccaroni, Marcello, Clarizia, Roberto, Ceccarello, Matteo, De Mitri, Paola, Roviglione, Giovanni, Mautone, Daniele, Caleffi, Giuseppe, Molinari, Alberto, Ruffo, Giacomo, Cavalleri, Stefano
• Format: Article
• Language: English
• Subjects: Bladder; Endometrial cancer; Endometriosis; Gynecological surgery; Gynecology; Hospitals; Laparoscopy; Medical referrals; Medicine; Medicine & Public Health; Original Article; Pain; Quality of life; Reproductive health; Surgery; Surgical outcomes; Urogenital system; Urological surgery; Urology; Womens health
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-019-04107-4

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.