This 30 year first saw me in 2005 at 19 years of age with a problem of an endometrioma. She underwent a laparoscopic cystectomy. She was single at that time. Postoperatively, she received 3 doses of monthly GnRH analogue injection. She was last seen in 2006 and was well. She conceived spontaneously after that and delivered 2 babies in 2007 and 2010. She was seen again in April 2016 complaining of hematuria and frequency of micturition. She had seen a urologist 6 months earlier. Cystoscopy done showed bladder endometriosis. No further surgery was performed and she was given GnRH analogues for 6 months. However her symptoms persisted after completion of the GnRH analogue.
Examination and ultrasound showed a large bladder nodule. IVU showed stricture in the upper right ureter. She underwent a combined urology and gynaecology surgery.
Stents were first placed in both the ureters. Laparoscopy showed a large bladder nodule which was adherent to the uterus. She also had many small endometriotic nodules. The bladder was released from the uterus. The urologist demarcated the bladder endometriosis using a transurethral resectoscope. The bladder endometriotic nodule was excised. The bladder was repaired continuously using polyglatin 3-0 sutures.
She subsequently conceived again and delivered her third child in 2017.