Laparoscopic Partial Bladder Cystectomy for Bladder Endometriosis

CASE HISTORY

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.

The 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.

Figure 1: Ultrasound of the bladder

Figure 2: Stents were placed in both ureters

Figure 3: Bladder was adherent to the uterus with a nodule.

Figure 4: Bladder nodule on cystoscopy

Figure 5: Cystoscopic demarcation of the bladder nodule.

Figure 6.The bladder nodule was cut cystoscopically

Figure 7: Resection of the endometriotic nodule via the bladder is seen laparoscopically

Figure 8: Bladder perforated cystoscopically.

Figure 9: Bladder nodule excisied laparoscopically.

Figure 10: Bladder sutured in 1 layer continuously with polyglactin 3-0..

Figure 11: Bladder repair completed

Figure 12: Bladder nodule

Conclusion

In bladder endometriosis, a combined approach with the urologist can assist in safely excising deep bladder endometriosis. Stents placed in the ureter assist in avoiding injury to the ureters. Demarcating the endometriotic nodule by the urologist through the bladder and excising the bladder nodule laparoscopically is both safe and effective.

Please watch the video at:

https;//vimeo.com/163190083
https://www.youtube.com/watch?v=03-zoFRbmv8&t=103s

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