Laparoscopic extramucosal partial bladder resection in a patient with symptomatic deep-infiltrating endometriosis of the bladder, adenomyosis uteri and asymptomatic deep-infiltrating endometrio-sis of the rectum

Endometriosis is a chronic endocrine-dependent disease of the uterine tissues characterized by proliferating endometrium-like tissue outside the uterine cavity. It is a potentially debilitating condition which is prevalent in about 10 to 15% of the female population. Involvement of the urinary tract by endometriosis is estimated in 1 to 2% of all cases, most frequently affecting the bladder. Deep infiltrating endometriosis of the bladder is defined as endometriotic lesions infiltrating the bladder muscularis propria⁶. In general, patients suffer from pelvic pain as well as from cyclic dysuria. Macro- or microhematuria during menstruation is pathognomonic but seems to be detectable in only 20% of patients. These symptoms are due to the endometriotic infiltration of the bladder's muscle layers leading to ineffective and painful bladder contractions as well as disturbed circulation in the bladder mucosa. The lesions are typically located posterior to the trigone or on the bladder dome. The importance of treatment lies, firstly, in alleviating the patient's symptoms and, secondly, in preventing renal insufficiency or loss of kidney function due to involvement of the ureters⁹. The first line treatment is laparoscopic partial bladder resection. Chapron et al. point out the importance of resecting through healthy tissue. As the lesion originates from outside the bladder, transurethral resection is not an appropriate treatment. Here, we describe a case of bladder involvement which was successfully resected extramucosally.