Annals of PIMS-Editorial Board

Endometriosis is a common gynaecological condition affecting 10% of the women in general population. The most frequent sites of endometriosis are ovaries, pelvic walls and pouch of Douglas. Bladder endometriosis is a rare form seen in 1% of cases. Isolated cases of bladder endometriosis are usually iatrogenic and result from pelvic surgery. We report a case of bladder endometriosis that developed after cesarean section. Partial Cystectomy was performed successfully.
Keywords: Endometriosis, Urinary Bladder

Introduction

Endometriosis is the implantation of the endometrial tissue at the sites other than uterine cavity. The first case of endometriosis was reported in 1921.¹The overall incidence in the general population is 10%. However, 40% of the women with infertility and 60% of those presenting with pelvic pain have endometriosis.²Urinary tract endometriosis as sole form of presentation is unusual. Bladder is the most common site of urinary tract endometriosis and affects about 1-2% of women with endometriosis.^3,4Fewer than 200 cases are reported in the world literature.⁴ It affects comparatively older age group and is reported even in post menopausal women.⁵
Case Report

A 26 years old women P₁⁺⁰, presented with the complaint of painful micturition during menstruation and lower abdominal pain for three years following caesarean delivery. There was no associated gross hematuria, urgency, frequency or fever. Menstrual cycle was regular with average blood loss but there was complaint of gradually increasing lower abdominal pain for the last three years. Medical treatment for suspected urinary tract infection was unsuccessful. Examination was unremarkable. Urinalysis revealed hemoglobinuria during menstruation. Ultrasonography showed a tract extending from uterine scar to bladder. Provisional diagnosis of scar site endometriosis was made. Cystoscopy was unremarkable and hysteroscopy revealed distorted uterine cavity in the region of anterior wall. At laparotomy, bladder was adherent to the uterine scar and 4 x3 cm endometriotic mass was found in the posterior wall of bladder (Figure I). Bladder was separated from the uterine scar with uretheral catheter left for 7 days. The histological diagnosis was bladder endometriosis (Figure II). Postoperative course was uneventful and symptoms resolved completely after resection of bladder endometriosis.