Deep Endometriosis of the Bladder is a relatively rare condition affecting the bladder, particularly the Trigone region. It can coexist with nodular endometriosis in other areas such as the Pouch of Douglas, bowel (intestines), ureter, and parametrium. Unusual sites outside the pelvis, such as scar tissue, the umbilicus, and the diaphragm, may also be involved in rare cases.
Differentiating Deep Endometriosis of the Bladder from typical endometriosis is crucial, as it features a higher degree of fibrosis and fewer glands and stroma. This form of endometriosis often coexists with Ovarian Endometriosis, also known as a chocolate cyst.
Patients with Deep Endometriosis of the bladder may experience symptoms such as pain or bleeding during urination. This pain can persist despite medication. If the Endometriosis affects the ureter, patients may develop hydronephrosis, causing loin pain due to kidney pressure changes.
Currently, there is no effective medical management for Deep Endometriosis of the bladder. Despite some claims of a cure, the reality is that due to its limited gland component, this type of Endometriosis cannot be resolved with medication alone.
Temporary relief of pain may be achieved with medications like Dinogest, Leupride, or GnRH Agonist Depot. However, for definitive treatment, a complete endometriosis excision via surgery is recommended.
Many young women may be misinformed about treatment options and are often prescribed medical management instead of surgery.
The only viable treatment option for Deep Endometriosis is surgery through 3D Laparoscopy. The key challenge is to reduce Adenomyosis and Endometriosis while preserving the tubes, necessitating the skills of experienced surgeons.
When performed by a specialist, laparoscopic surgery can improve fertility, enabling patients with normal Fallopian tubes to conceive naturally. Additionally, expert laparoscopic surgery can reduce the recurrence rate of Deep Endometriosis to less than 3%.
In practice, 2-4% of patients choose Robotic Surgery over Laparoscopic Surgery, believing it to be safer. However, existing literature indicates that Robotic Surgery does not offer additional benefits compared to Laparoscopic Surgery for Endometriosis, even for deep lesions.
The incidence of Deep Endometriosis of the bladder in younger individuals is increasing, thanks to advancements in diagnostic techniques. High-quality ultrasound technology is particularly effective for diagnosis, often requiring a partially filled bladder for optimal results.
Ultrasound is the preferred diagnostic method for Deep Endometriosis of the Bladder, provided it is conducted by a specialized unit skilled in this technique and disease mapping. Accurate mapping of endometriosis can achieve up to 85-90% accuracy with proper expertise.
While Deep Endometriosis can be fully removed by a skilled surgical team, recurrence is still possible.
After surgery, most patients do not require medical management if the surgical resolution is complete.
Expert surgeons use specialized techniques, including Radical Excision and complete clearance of Bladder Endometriosis, to ensure thorough treatment.
These techniques have been documented and are widely recognized for their effectiveness in treating Endometriosis, including cases of Bladder Endometriosis.
In summary, Deep Endometriosis of the bladder is a complex condition that demands expert care for accurate diagnosis and effective treatment. Patients should be well-informed about their options to make the best decisions for their health.
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