Bladder endometriosis: getting closer and closer to the unifying metastatic hypothesis

Somigliana, Edgardo; Vercellini, Paolo; Gattei, Umberto; Chopin, Nicolás; Chiodo, Ilda; Chapron, Charles

doi:10.1016/j.fertnstert.2006.11.090

Cited by 88 publications

(70 citation statements)

References 18 publications

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“…In other words, in two cases out of three the bladder DIE nodule was associated with other posterior DIE lesions (USL, vagina, intestine, ureter). Association of bladder endometriosis with other forms of the disease has been reported previously (Donnez et al, 2000;Fedele et al, 2005a, b;Somigliana et al, 2007). Contrary to Vercellini et al (1996) however, we did not observe that patients with previous history of C-section presented significantly fewer associated DIE lesions.…”

Section: Discussioncontrasting

confidence: 64%

“…Contrary to Vercellini et al (1996) however, we did not observe that patients with previous history of C-section presented significantly fewer associated DIE lesions. Concerning the pathogenesis of these lesions, our findings indicate that bladder DIE nodules should not be considered as an independent form of the disease (Somigliana et al, 2007). The multifocal distribution of DIE lesions indeed prompted us to cease considering this disease as a single organ pathology but rather, to see it as an 'abdomino-pelvic multifocal pathology'.…”

Section: Discussionmentioning

confidence: 80%

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Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

et al. 2010

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background: Deep infiltrating endometriosis (DIE) is presented as a disease with high recurrence risk. Bladder DIE is the most frequent location in cases of urinary endometriosis. Surgical removal has been recommended for bladder DIE but long-term outcomes remains unevaluated. The objectives of this study are to evaluate the rate of recurrence after partial cystectomy for patients presenting with bladder DIE and to outline the surgical modalities for handling associated posterior DIE nodules.methods: Seventy-five consecutive patients with histologically proved bladder DIE were enrolled at a single tertiary academic center between June 1992 and December 2007. A partial cystectomy was performed for each patient. Complete surgical exeresis of all associated symptomatic DIE lesions was carried out during the same surgical procedure. Bladder DIE patients were classified into three groups: patients with isolated bladder DIE (Group A); patients with associated symptomatic posterior DIE (Group B); patients with associated asymptomatic posterior DIE (Group C). Bladder DIE recurrence was defined as a clinical reappearance of the disease or radiological evidence that mandated a new surgical procedure. We assessed pelvic pain symptoms pre-and post-operatively using a 10-cm visual analogue scale.results: In a series of 627 patients with DIE, we observed 75 patients (12%) with bladder DIE. With a 50.9 + 44.6 months mean followup after partial cystectomy no patient presented evidence of bladder DIE recurrence. Post-operatively, we observed a significant improvement with respect to pain symptoms, with only two patients (2.7%) developing major complications during follow-up. Among patients with non-operated associated asymptomatic posterior DIE lesions (n ¼ 15), a second surgical procedure indicated for pain symptoms was necessary in only one patient (6.7%).conclusions: For patients presenting with bladder DIE, no patients required further surgery for bladder recurrence after radical surgery consisting in partial cystectomy. Exeresis of associated posterior DIE nodules is indicated only when they are symptomatic.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 80%

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

et al. 2010

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“…Support for this hypothesis stems from the pathological findings of hyperplasia of smooth-muscle cells surrounding the affected ureter, with sparse endometriotic glands and scant stroma in surgical specimens of women who had undergone segmental ureteral resection [31]. The histological appearance of ureteral implants resembling that of adenomyosis has led some investigators to introduce the concept of adenomyotic disease of the retroperitoneal space, postulating a primary development of endometriosis in the retroperitoneum from the embryonic remains of the Müllerian duct [31]. The lateral spread of retroperitoneal lesions up to and around the ureter would explain endometriosis localization by proliferation of the smooth muscle surrounding the ureteral wall [30].…”

Section: Resultsmentioning

confidence: 99%

“…Several authors have observed a positive correlation between having UE and the incapacitating dysmenorrhea and associated lesions of the retrocervical region or the rectum-sigmoid [4,31]. …”

Section: Resultsmentioning

confidence: 99%

Ureteral Endometriosis: Proposal for a Diagnostic and Therapeutic Algorithm with a Review of the Literature

Maccagnano¹,

Pellucchi²,

Rocchini³

et al. 2013

Urol Int

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Introduction: The ureteral involvement in deep pelvic endometriosis in usually asymptomatic and might lead to a silent loss of renal function. As a matter of fact, the diagnosis and the treatment modalities are still a matter of debate. Materials and Methods: We performed a literature review by searching the MEDLINE database for articles published in English between 1996 and 2010, using the key words urinary tract endometriosis, ureteral endometriosis, diagnosis and treatment. We found more than 200 cases of ureteral endometriosis (UE). Results: The disease most commonly affects a single distal segment of the ureter, with a left predisposition in most of the patients. Two major pathological types of UE may be distinguished: intrinsic and extrinsic. The symptoms are usually nonspecific and owing to secondary obstruction. The diagnosis has to be considered as a step- by-step procedure, starting from physical examination to highly detailed imaging methods. Nowadays, the treatment is usually chosen according to the type of UE, the site lesion and the distance to the ureteral orifice, with the use of JJ stents remaining a matter of debate. Conclusions: A close collaboration between the gynecologist and the urologist is advisable, especially in referral centers. Surgical treatment can lead to good results in terms of both patient compliance and prognosis.

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“…[6][7][8][9] Multiple pathogenic causes for the ectopic occurrence of endometriosis have been proposed. They include (1) an endometrial implantation theory based on the reflux of menstrual blood through the oviducts; (2) a coelomic metaplasia theory involving differentiation in peritoneal mesothelial cells; (3) theories of lymphogenous or hematogenous routes involving lymphatic and vascular metastases; (4) a mechanical transplant theory involving the persistence of remnants of endometrium following a spontaneous or operative delivery; (5) an embryonic remnant theory based on residues of Wolffian or Müllerian ducts; (6) a composite theory based on a combination of the implantation and metastasis theories; and (7) a recent hypothesis based on the involvement of local immune factors.…”

Section: Discussionmentioning

confidence: 99%

Scar Endometriosis in a Patient With Bladder Exstrophy

Kitajima

Inoue

Uchida

et al. 2013

International Surgery

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Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence.

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Bladder endometriosis: getting closer and closer to the unifying metastatic hypothesis

Cited by 88 publications

References 18 publications

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Ureteral Endometriosis: Proposal for a Diagnostic and Therapeutic Algorithm with a Review of the Literature

Scar Endometriosis in a Patient With Bladder Exstrophy

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