Endometriosis of the Bladder: Clinical and Surgical Outcomes after Laparoscopic Surgery.

BACKGROUND/AIMS: Urinary tract endometriosis is rare. The bladder is the most common site affected. The nonspecific symptoms can make a diagnosis difficult. The aim of this study was to evaluate the clinical and surgical outcomes in women who underwent surgical treatment for bladder endometriosis (BE). METHODS: Ten patients who underwent surgical treatment for BE from January 2012 to November 2016 were retrospectively reviewed. Pre- and postoperative data, intraoperative findings, type of surgical procedure, and intra- and postoperative complications were analyzed. RESULTS: Two women were treated by laparoscopic shaving of the bladder lesion and 8 underwent laparoscopic partial cystectomy. Simultaneous resection of coexisting pelvic nodules was performed. No conversions to laparotomy were observed. There was only one intraoperative complication. No major or minor postoperative complications were observed and none of the patients required repeated interventions. Improvements in clinical symptoms were reported and there was no increase in long-term urinary frequency after surgery. There was 1 case of urinary symptom recurrence. CONCLUSION: Laparoscopic partial cystectomy and shaving of the bladder lesion seem to improve urinary symptoms, with a low rate of intra- and postoperative complications and a low rate of recurrence, without affecting long-term bladder capacity. This surgical approach requires an experienced gynecologist and urologist team.

Rectovaginal Splenosis: An Unexpected Cause of Dyspareunia Approached by Laparoscopy.

STUDY OBJECTIVE: To demonstrate the technique of laparoscopic approach in a rare case of rectovaginal splenosis with severe dyspareunia and dyschesia. DESIGN: A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results (Canadian Task Force classification II-3). SETTING: Splenosis consists of ectopic functioning splenic tissue that can be located anywhere within the abdomen or pelvis. Fragments are often multiple and range in diameter from a few millimeters to a few centimeters. They are reddish-blue and are sessile or pedunculated. Their appearance can mimic that of neoplasms or endometriosis, which are the main differential diagnoses. Trauma and subsequent splenectomy is the cause in most cases. Splenosis is a benign condition usually found incidentally and is usually asymptomatic. The need for therapy is controversial, and treatment is suggested only in symptomatic cases, primarily those related to pelvic or abdominal lesions, as in our patient. The diagnosis of splenosis in a woman complaining of pelvic pain may present diagnostic difficulties. The splenic tissue has the macroscopic appearance of endometriosis, and its position in the pelvis also may suggest this diagnosis. Where excision of splenosis is considered necessary, the approach should be laparoscopic, unless this is considered too risky owing to the proximity of vital structures. INTERVENTION: A 40-year-old woman was referred to our department for severe dyspareunia and dyschezia. The gynecologic examination revealed a painfull nodularity on the posterior vaginal cul de sac. Further evaluation with 2- and 3-dimensional ultrasound and magnetic resonance imaging revealed several soft tissue nodules in the pouch of Douglas (POD), which were enhanced on contrast administration. She had undergone a splenectomy 15 years earlier after a car accident. A laparoscopic approach to a rectovaginal nodularity was performed. Under general anesthesia, the patient was placed in the dorsal decubitus position with her arms alongside her body and her legs in abduction. Pneumoperitoneum was achieved using a Veres needle placed at the umbilicus. Four trocars were placed: a 10-mm trocar at the umbilicus for the 0-degree laparoscope; a 5-mm trocar at the right anterosuperior iliac spine; a 5-mm trocar in the midline between the umbilicus and the pubic symphysis, approximately 8 to 10 cm inferior to the umbilical trocar; and a 5-mm trocar at the left anterosuperior iliac spine. The entire pelvis was inspected for endometriotic lesions. In the pelvis, hypervascular and bluish nodules were visible with extension from the POD into the deep rectovaginal space. The macroscopic appearance was atypical for endometriotic implants. The nodularities were carefully dissected and excised, and histological assessment revealed splenic tissue. At the time of this report, the patient had been asymptomatic for 6 months after surgery. CONCLUSION: Rectovaginal splenosis may mimic endometriosis. The laparoscopic approach to rectovaginal splenosis avoids an abdominal incision, with its associated pain and possible adhesion formation. It also provides a better view for dissection. In this patient, the splenosis was removed by laparoscopy, with no postoperative dyspareunia or dyschesia.