Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up

Objective

To evaluate surgical outcome and long-term follow-up of conservative laparoscopic management of urinary tract endometriosis (UTE).

Design

Prospective study.

Setting

Tertiary-care university hospital.

Patient(s)

Women with laparoscopic diagnosis and histologic confirmation of urinary bladder or ureteral endometriosis who agreed to undergo long-term follow-up after laparoscopic management.

Intervention(s)

(1) Laparoscopic partial cystectomy for bladder endometriosis. (2) Uretric endometriosis laparoscopically managed by: uretrolysis only; segmental ureterectomy and terminoterminal anastomosis; or segmental ureterectomy and uretrocystoneostomy.

Main Outcome Measure(s)

Variables assessed were: preoperative findings, operative details (type and site of UTE, type of intervention, perioperative complications), and long-term follow-up (persistence/recurrence of preoperative urinary symptoms, if present, and anatomic relapse of the disease).

Result(s)

Mean operating time was 152.8 ± 41.7 minutes. Mean drop in hemoglobin was 1.9 ± 1.6 g/dL. Average hospital stay was 6 days. After surgery, 11 women had fever >38°C and four presented transient urinary retention. During a follow-up period of 36 months, endometriosis recurred in eight patients with no evidence of bladder or ureteral reinvolvement, and there was a significant reduction in the mean score of dysuria and suprapubic pain maintained during the whole follow-up period.

Conclusion(s)

Results of long-term follow-up demonstrate significant reduction in preoperative symptoms with no anatomic relapse

Key Words: Bladder endometriosis, laparoscopy, laparoscopic partial cystectomy, long-term follow-up, ureteral endometriosis