Endometriosis, a condition where uterine tissue grows outside the uterus, can affect the bladder. This article discusses a case of bladder endometriosis successfully treated using a partial cystectomy, combining laparoscopic and transurethral techniques. This innovative approach allows for precise removal of the lesion while minimizing damage to healthy bladder tissue.
Bladder endometriosis, characterized by endometrial tissue within the bladder wall, often presents with symptoms like pelvic pain and urinary issues. While hormonal therapy can offer temporary relief, surgical excision is often the preferred treatment for long-term resolution. Laparoscopic partial cystectomy is a minimally invasive procedure that removes the affected portion of the bladder. However, accurately identifying the lesion’s boundaries can be challenging.
This case report details a 44-year-old woman with a history of Cesarean delivery and hysterectomy who presented with a bladder mass discovered during an ultrasound. Initial cystoscopy and biopsy revealed chronic inflammation. A subsequent CT scan confirmed a mass with solid and cystic components protruding into the bladder. The medical team opted for a combined laparoscopic and transurethral approach for partial cystectomy.
The procedure involved using a transurethral Colling’s knife to create a circumferential incision around the mass under cystoscopic guidance. Laparoscopically, the marked incision line was easily visualized by temporarily turning off the laparoscopic light source. This precise demarcation allowed for en bloc resection of the mass using ultrasonic scissors, minimizing the removal of healthy bladder tissue. The bladder defect was then closed with sutures. Pathological analysis confirmed bladder endometriosis.
Figure 1. Cystoscopic view of the bladder mass with a circumferential incision made using a Colling’s knife. This incision marks the boundary for resection.
The combined laparoscopic and transurethral approach offers significant advantages in partial cystectomy for bladder endometriosis. The transurethral incision provides a clear visual guide for laparoscopic resection, ensuring accurate removal of the lesion while preserving healthy tissue. This technique reduces the risk of incomplete excision and minimizes potential complications.
Figure 2. Laparoscopic view of the bladder with the marked incision line illuminated by turning off the laparoscopic light. This technique facilitates precise excision of the mass.
This case highlights the effectiveness of the combined surgical approach. The patient recovered well, and the endometrial tissue was completely removed. This technique allows for precise and complete removal of the lesion. It may improve surgical outcomes and minimize morbidity compared to traditional laparoscopic partial cystectomy alone.
Figure 3. Laparoscopic view of the en bloc resection of the bladder mass using ultrasonic scissors, following the marked incision line. This ensures complete removal of the lesion.
While retrograde menstruation is the most widely accepted theory explaining endometriosis, other factors like coelomic metaplasia and immune system dysregulation might also contribute. Urinary tract endometriosis, though considered rare, can significantly impact a woman’s quality of life.
Figure 4. Laparoscopic view of the closure of the bladder defect using sutures. This completes the partial cystectomy procedure.
This combined laparoscopic and transurethral partial cystectomy provides a safe and effective surgical option for managing bladder endometriosis. The precise demarcation of the lesion facilitated by the transurethral incision allows for complete removal while preserving healthy bladder tissue. This technique offers a promising approach for treating this challenging condition.
