Isolated Bladder Endometriosis in a Patient With Previous Cesarean Sections

Abstract

Urological endometriosis is rare and accounts for approximately 1% of women with endometriosis. The pathophysiology of bladder endometriosis may be divided into two different causes, namely primary and secondary. The primary form occurs spontaneously and manifests in a form of a generalized pelvic disease whereas the secondary form is thought to be iatrogenic and typically occurs after pelvic surgery such as Cesarean section or hysterectomy. We present a case report on a patient presenting with an invasive bladder mass initially thought to be from a pelvic malignancy. The final histology showed isolated bladder endometriosis. She had a significant past medical history of two previous Cesarean sections. A review of her magnetic resonance imaging (MRI) images demonstrated the presence of a Cesarean scar niche which may be linked to her bladder endometriosis. There is a need to improve awareness of the possible link between Cesarean scar niche with bladder endometriosis. This is important as it raises the clinical question of whether appropriate repair of Cesarean scar niches can prevent future complications such as bladder endometriosis which can potentially be associated with significant morbidity.

Bladder endometeriosis with recurrent urinary tract infection as a rare case report

“…Studies have shown that the assessment of urinary bladder deformities relies on the use of techniques such as uroscopy, magnetic resonance imaging. The research emphasizes the role of cystoscopy in diagnosing these deformities and even the possibility of taking samples for con rmation [1]. In our patient, upon conducting some laboratory tests, the following ndings were observed: Urine analysis: the eld is lled with red blood cells, Creatinine: 1 and INR: 2.5.…”

“…In a study conducted by Vercellini and colleagues, they observed bladder abnormalities in only two out of 40 women, noting that these two women did not experience any symptoms. The absence of periodic symptoms for pelvic uterine abnormalities may be related to the use of Mirena [1]. In the case of our patient, a 37-year-old married woman with a child, she has been suffering from recurrent urinary tract infections for a year, experiencing burning during urination and pelvic pain for three years.…”

“…This was evident in our patient who had a cesarean section ve years ago and underwent ( Intracytoplasmic Sperm Injetion ) ICSI tube baby. In a previous study, Donnez and colleagues analyzed a series of cases and found that 4 out of 17 patients had undergone previous cesarean sections [1]. The clinical presentation of patients with bladder endometriosis (BE) varies signi cantly based on the size and location of the lesion.…”

“…The rate of urinary system infection is very rare, about 1% [1]. The most common site of urinary tract involvement is the bladder, especially its posterior wall near the uterus [2].The exact cause of endometriosis is unknown, with theories including retrograde menstruation and hematogenous or lymphatic spread of endometrial cells [1]. Women with bladder endometriosis often experience pelvic pain, urinary urgency, recurrent urinary tract infections, discomfort during urination, blood in the urine during menstruation, dysuria, and dyspareunia [3].…”