Bladder endometriosis: conservative management.

PURPOSE: We evaluate the characteristics of women with bladder endometriosis successfully treated with hormonal therapy. MATERIALS AND METHODS: The records of 14 patients with a mean age of 48.7 years (range 26 to 71) diagnosed with bladder endometriosis on cystoscopic evaluation were reviewed for presenting complaints, findings and response to therapy. RESULTS: The most frequent presenting complaints were urgency (78%), frequency (71%), suprapubic pain (43%), urge incontinence (21%) and dyspareunia (21%). Of the patients 86% did not have a history of recurrent urinary tract infections, 6 (42%) had a history of endometriosis, including 3 who were previously treated with hysterectomy/oophorectomy and 8 (57%) were on some form of therapy for estrogen deficiency. In all patients endometrial implants were identified on cystoscopic examination. In 2 patients the endometrioma correlated to lesions on the serosal surface of the bladder during laparoscopic evaluation. Of the patients 13 were treated either with low dose oral contraceptives, decrease or elimination of the estrogen component of the present regimen or addition of progesterone to therapy, and 12 (92%) reported sustained improvement of symptoms at a mean of 18.6 months (range 8 to 24). CONCLUSIONS: In more than 70% of cases the presenting symptoms of bladder endometriosis are identical to those of interstitial cystitis. Therefore, endometriosis should always be considered in the patient referred for frequency, urgency and pain with no documented infection. Hormonal therapy is reasonable and effective management for bladder endometriosis. This option preserves fertility, making it especially attractive to younger women.

Duke Scholars

Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology