Figure - available from: Case Reports in Urology
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The anterograde pyelography was taken through the nephrostomy catheter and the contrast material was not transmitted to the bladder in the ureterovesical junction.
Source publication
The incidence of endometriosis cases involving the urinary system has recently increased, and the bladder is a specific zone where endometriosis is most commonly seen in the urinary system. In the case presented here, a patient presented to the emergency department with the complaint of side pain and was examined and diagnosed with severe hydroneph...
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Isolated shwannoma of the urinary bladder is a very rare entity. We report a case of a shwannoma of the bladder that was diagnosed by an MRI and confirmed by histopathology after the patient underwent TURB.
Citations
... A conservative hormone therapy without surgical cleanup of endometriomas is only justified when the urogenital endometriosis still displays an adequate renal function and is continuously monitored. 18 ...
In aggressive cases, endometriosis can perturb the urogenital tract, in particular the ureter, which can potentially result in ureteral compression or stenosis. Even though this is rare, consequences are dramatic, such as hydronephrosis or organ failure. The present standard intervention comprises the resection of affected tissues and endometriosis foci combined with adjuvant hormonal therapy. When the ureter does not recover, ureteral reimplantation is required. The present case describes the successful laparoscopic approach of the reimplantation of the ureter with simultaneous cystoscopy.
... However, our experience of performing laparoscopic excision with or without the robotic arm indicates that medical management of ureteral endometriosis is risky, as endometriosis is a progressive disease. The ultimate goal of medical management is to induce regression of endometrial tissue and to prevent endometriotic tissue proliferation and ureteral obstruction with resulting loss of kidney function 67 . Medical therapy often involves the use of hypoestrogenizing medications such as GnRH analogues including leuprolide acetate, danzol, combined contraceptives, or progestin, and aromatase inhibitors such as letrazole; these can be considered for those with mild and/or early stage disease, or if patients decline or defer surgery 47 . ...
... Treatment of DIE using pharmacological therapies such as GnRH analogues is often unsuccessful and can result in bothersome effects including hot flashes, sleep disturbances, breakthrough bleeding, weight gain, and vaginal dryness 67 . Furthermore, recurrence of symptoms is common once medications are discontinued 40 . ...
Endometriosis predominantly affects the pelvic reproductive organs but can also affect the urinary tract. A number of theories for the pathogenesis of endometriosis have been suggested, but the exact mechanisms remain elusive. Endometriotic lesions can be found on both the ureter and bladder, and the optimal therapeutic approach depends on the extent, depth, and location of these lesions. Medical approaches, including hormonal therapies such as GnRH agonists and oral contraceptives, tend to be a temporary measure, but can be useful in a preoperative setting or if the patient is unsuitable for surgery, and are also useful as a postoperative treatment. If surgical resection is deemed appropriate, laparoscopic management with or without robotic assistance of urological endometriosis is feasible and advisable. Newer techniques, such as nerve-sparing surgery, might help to decrease the risk of urinary complications following resection of deeply infiltrating endometriosis.
... To our knowledge, only one case of this kind of treatment has ever been reported (Gupta et al. 2011), with a positive result after one year of following period when published. A similar management concerning the implantation of a Levonorgestrel-IUD has also been published concerning bladder endometriosis, but it was invariably associated to urologic surgery (cystoscopic resection plus temporary nephrostomy), and the follow up was for only 12 months (Efe et al. 2014). These cases both support the positive results of this conservative management: Levonorgestrel-IUD has shown to have strong effectiveness as a postoperative therapy (conservative surgery plus the temporary insertion of a double-pigtail stent). ...
Endometriosis can affect up to 10% of women of reproductive age, in a wide range of clinical presentations that vary from mild to severe or deep endometriosis. Deep endometriosis can affect the urinary tract in 1–5% to 15–25% cases. Even though deep endometriosis’ surgeries are usually complex with higher rate of complications, conservative management is not always considered as an option because of its high failure rates. This paper describes two cases of deep endometriosis with ureteric involvement (hydronephrosis) treated conservatively with a double-pigtail stent plus a Levonorgestrel intrauterine device, after conservative surgery, who remained symptom free with no evidence of recurrence at 3 years follow-up, avoiding radical high-risk surgery.
• Impact statement
• Several treatments have been described for endometriosis. From a symptomatic perspective, conservative medical management has been proposed with a variable response. Concerning deep endometriosis (affecting the urinary or digestive tract), the definitive treatment has always been thought to be radical surgery. However, this can lead to several complications.
• To illustrate a possible more conservative approach this paper describes two cases of deep infiltrating endometriosis affecting the ureter, treated conservatively with a temporary pigtail ureter stent plus a Levonorgestrel intrauterine device. The management demonstrates that, in a selected population, conservative treatment solves the urinary disease avoiding the surgical complications and, what is more, improving patients’ symptoms in a permanent way.
• Further prospective studies are needed to confirm whether the introduction of this management in clinical practice would reduce the need for surgery thereby, avoiding high-risk surgery and improving the success rate of conservative management.
... Dysmenorrhea, pelvic pain, and deep dyspareunia significantly improved and the size of the endometriotic nodules decreased during treatment. More recently, a case of a woman with severe hydronephrosis caused by bladder endometriosis was successfully managed with percutaneous nephrostomy and subsequent levonorgestrel-releasing intrauterine system treatment (106). ...
Pain is the most evident clinical manifestation of deep infiltrating endometriosis (DIE). Several hormonal and immunologic mechanisms are markedly altered in DIE compared with superficial peritoneal and ovarian endometriosis, and may explain its most aggressive behavior and the presence of severe pain symptoms. Hormonal therapies, such as combined hormonal contraceptives and progestogens, should be regarded as first-line treatment, as they are efficacious, safe, and well tolerated. Gonadotropin-releasing hormone agonists may be used in patients with symptoms persisting after the administration of first-line therapies. Scanty literature is available for danazol treatment in patients with DIE and, however, it has become less popular due to the high rates of androgenic adverse events (AEs). The partial relief of pain that often is achieved with available therapies and its recurrence after the suspension of the treatment have brought to the development of new therapies (such as aromatase inhibitors, oral GnRH antagonists) that are currently under investigation. Surgical excision of DIE should be considered in patients with pain symptoms persisting after first-line hormonal therapies. The benefits of surgery in terms of pain improvement should be always balanced with the risk of intraoperative complications and for this reason surgical cases should be referred to tertiary centers for the treatment of DIE. A multidisciplinary approach is mandatory in patients with DIE involving the bowel and/or the urinary tract.
Endometriosis with its estimated incidence rate of ∼7–10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon’s experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.
Endometriosis is a common cause of infertility and disabling pelvic pain in reproductive age women. The most widely accepted theory of its pathogenesis is the retrograde flow of menstrual products, although extra-abdominal and extrapelvic diagnoses have been made. After the pelvic peritoneum and gynecologic structures, the most commonly affected sites are the lower gastrointestinal and urinary tracts. When the urinary tract is involved, the bladder is the predominant site, followed by the ureters. The focus of this seminar will thus be these two anatomic sites. Delayed diagnosis is unfortunately common for endometriosis as a whole, but more so when extrapelvic sites are involved. While the first-line therapy for endometriosis is medical management, urinary tract involvement often represents advanced stage of the disease, thereby requiring surgical intervention. With timely diagnosis and intervention by skilled gynecologic or urologic surgeons, favorable outcomes can be attained.
