A case of Large Urinary Bladder Endometriosis

Laparoscopic Excision of Urinary Bladder Endometriosis with repair
Dr Uddhavraj Dudhedia Dr Manek Potwar Dr Devki Potwar
Minimal Access Gyn-oncological, Neuropelvic, and Urogynaecological surgery
St. Elizabeth Hospital, Mumbai, India

Clinical Details: 29 years old lady with chief complaints:

1. difficulty in conceiving since 3 years
2. Severe dysmenorrhea since 3 -4 years
3. Episodes of hematuria during periods since 3-4 months
4. Pain in lower abdomen, persisting after periods

Ultrasound pelvis suggested:
Bulky uterus, with ,mass at the isthmic region, indenting the bladder, measuring approximately 4X4 cm, bilateral ovarian masses s/o endometriomas ( 4×4 cm size each approx..)

MRI pelvis suggested:
Nodule invading bladder muscle and mucosa, more on the left side, and arising from the cervico-isthmic region. Bilateral ovarian endometriomas confirmed as well.

Procedure: Operative Laparoscopy, cystoscopy, followed by bilateral ureteric stenting, excision of bladder endometriosis, cystoplasty, with excision of bilateral ovarian endometriomas, with hysteroscopy and chromopertubation.

Post-Operative Course:
Ureteric stents were removed intra-operatively, after the bladder repair.
Patient mobilized in the evening.
She accepted liquids, followed by full diet within 24 hours.
She was discharged after 48 hours.
Bladder catheter was kept for 2 weeks.
Patient recovered well, with no complaints.
She was advised GnRH analogues, and referred to a fertility physician.