Bladder Endometriosis

Bladder endometriosis is a condition where endometrial tissue, which normally lines the uterus, grows outside of the uterus and attaches to the bladder.

Bladder endometriosis is a condition where endometrial tissue, which normally lines the uterus, grows outside of the uterus and attaches to the bladder. This condition is a type of endometriosis, a chronic and often painful disorder that affects women of reproductive age.

Bladder endometriosis may manifest in two forms: superficial, where it is limited to the bladder’s surface, or deeper, affecting the inner layers of the bladder wall. In rare instances, it can extend to the ureter, the tube connecting the kidney and the bladder. Additionally, bladder endometriosis can be classified as either primary, occurring spontaneously, or secondary, developing after pelvic surgery.

Image source: (Blausen Medical, 2014)

Causes of Bladder Endometriosis

The exact cause of bladder endometriosis is not fully understood, but there are several theories and factors that may contribute to its development. Here are some possible causes and factors associated with bladder endometriosis:

Retrograde menstruation: Retrograde menstruation is a common theory to explain the development of endometriosis. It occurs when menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. These displaced endometrial cells can attach and grow on the bladder or other pelvic organs.
Implantation theory: According to this theory, endometrial tissue can be transported to the bladder through the blood or lymphatic system. This may lead to the implantation and growth of endometrial cells on the bladder.
Metaplasia: Metaplasia refers to the transformation of one type of tissue into another. It is suggested that metaplastic changes in the cells lining the bladder may cause them to transform into endometrial-like cells, leading to bladder endometriosis.
Surgical scars: Previous surgeries in the pelvic area, such as cesarean sections or hysterectomies, may provide sites for endometrial cells to implant and grow outside the uterus, including on the bladder.
Genetic factors: There may be a genetic predisposition to developing endometriosis. If a close female relative, such as a mother or sister, has endometriosis, the risk of developing the condition may be higher.
Hormonal factors: Hormones, especially estrogen, play a crucial role in the development and growth of endometriosis. Hormonal imbalances or abnormalities may contribute to the development of bladder endometriosis.
Immune system dysfunction: An impaired immune response or dysfunction of the immune system may affect the body’s ability to recognize and eliminate ectopic endometrial cells. This can lead to their attachment and growth in the bladder.

It’s important to note that while these factors are associated with bladder endometriosis, the exact cause can vary from person to person. The condition is still not fully understood, and further research is needed to fully elucidate the underlying causes and mechanisms.

Symptoms of Bladder Endometriosis

The symptoms of bladder endometriosis can vary from person to person, but here are some common symptoms that individuals may experience:

Bladder pain: This is one of the primary symptoms of bladder endometriosis. The pain may be experienced as a dull ache, sharp pain, or cramping sensation in the bladder region. The pain can worsen during the menstrual cycle or during bladder filling and may improve after emptying the bladder.
Urinary frequency: Feeling the need to urinate more often than usual is a common symptom. Individuals with bladder endometriosis may experience increased urinary frequency, even with small amounts of urine.
Urgency: A sudden and compelling urge to urinate can occur with bladder endometriosis. This sensation may be difficult to control, and individuals may feel the need to rush to the bathroom.
Painful urination: Some individuals with bladder endometriosis may experience pain or discomfort during urination, known as dysuria. This can be a burning sensation or sharp pain in the urethra or bladder area.
Blood in the urine: In rare cases, bladder endometriosis can cause bleeding within the bladder, leading to the presence of blood in the urine (hematuria). This symptom should always be evaluated by a healthcare professional to determine its cause.
Pelvic pain: Bladder endometriosis can cause pelvic pain that may radiate to the bladder region. The pain may be chronic or cyclic, worsening during menstruation.

It’s important to note that these symptoms can also be associated with other urological conditions. If you experience any of these symptoms or suspect bladder endometriosis, it is recommended to consult with a healthcare professional specializing in endometriosis or urology for an accurate diagnosis and appropriate management.

Types of Bladder Endometriosis

Bladder endometriosis is a specific form of endometriosis where endometrial tissue grows and affects the bladder. There are two primary types of bladder endometriosis:

Superficial Bladder Endometriosis: Superficial bladder endometriosis refers to the presence of endometrial implants on the surface of the bladder. These implants can range in size and may be scattered across the bladder lining. Superficial bladder endometriosis typically affects the mucosal layer of the bladder.
Bladder Endometriosis Infiltrating the Bladder Wall: In this type, the endometrial tissue infiltrates and penetrates the muscular wall of the bladder. It may extend beyond the mucosal layer and invade the deeper layers of the bladder. This infiltration can cause structural changes and may lead to the formation of fibrotic nodules or adhesions.

Bladder endometriosis can also present in combination with other forms of endometriosis affecting nearby organs in the pelvic region. For example, it can coexist with endometriosis of the uterus, ovaries, fallopian tubes, or other surrounding structures.

It’s important to note that bladder endometriosis is a relatively rare form of endometriosis, with estimates suggesting it occurs in approximately 1-2% of women with endometriosis (Mettler, 2006).

Diagnosis of Bladder Endometriosis

The diagnosis of bladder endometriosis typically involves a combination of medical history evaluation, physical examination, imaging studies, and sometimes surgical intervention. Here are the main steps and methods used in the diagnosis of bladder endometriosis:

Medical history and symptom evaluation: Your healthcare provider will discuss your symptoms, including any pelvic pain, urinary symptoms, or abnormal menstrual cycles. They will inquire about your medical history, including any previous diagnosis or treatment for endometriosis.
Physical examination: A pelvic examination may be performed to assess for any abnormalities, tenderness, or masses in the pelvic region. However, bladder endometriosis may not be detected through a physical examination alone.
Imaging studies:
- Ultrasound: Transvaginal ultrasound or pelvic ultrasound may be used to visualize the pelvic organs, including the bladder, and detect any abnormalities or signs of endometriosis.
- Magnetic Resonance Imaging (MRI): An MRI may be recommended to obtain detailed images of the pelvic region. MRI can help identify endometrial lesions and their involvement with the bladder or adjacent structures.
Cystoscopy: Cystoscopy is a procedure in which a thin, flexible tube with a camera (cystoscope) is inserted into the urethra and advanced into the bladder. This allows for direct visualization of the bladder and the identification of any endometrial implants or lesions on the bladder wall. If suspicious lesions are found, a biopsy may be performed to confirm the presence of endometrial tissue.
Surgical exploration: In some cases, surgical exploration and excision of suspected endometrial lesions may be necessary for a definitive diagnosis. This may be performed through laparoscopy, a minimally invasive surgical procedure, where a camera and surgical instruments are inserted through small incisions in the abdomen. If bladder endometriosis is confirmed during surgery, excision or ablation of the lesions may be performed.

It’s important to consult with a healthcare professional who specializes in endometriosis or urology for an accurate diagnosis. They will guide you through the appropriate diagnostic steps based on your symptoms, medical history, and physical examination findings.

Surgical Methods for Bladder Endometriosis Treatment

Surgical treatment is often required to manage bladder endometriosis effectively. Here are some surgical methods commonly used for bladder endometriosis treatment:

Transurethral Resection of Bladder Endometriosis (TURBE)

This procedure involves using a cystoscope (a thin, flexible tube with a camera) inserted through the urethra to visualize and remove endometrial implants on the bladder wall. It is a minimally invasive procedure and is suitable for smaller lesions or superficial involvement of the bladder.

Since healthcare costs can change over time and vary between different regions, it is difficult to provide an exact figure for the cost of TURBE in the United States. However, on average, the cost of a TURBE procedure can range from approximately $5,000 to $15,000 or more. This estimate includes the surgeon’s fees, facility fees, anesthesia, and other associated costs.

To get an accurate cost estimate, it is advisable to request an appointment with New York Gynecology Endometriosis (NYGE).

Robotic-Assisted Laparoscopy

Robotic-assisted laparoscopy, also known as robotic-assisted bladder surgery, is a surgical technique that combines laparoscopic surgery with robotic technology to treat bladder endometriosis. This involves using a robotic platform like the da Vinci Surgical System to assist the surgeon in performing precise and controlled movements during the procedure.

The integration of robotic technology in bladder surgery offers several potential benefits, including improved surgical visualization, enhanced surgical precision, and a lower risk of complications. However, it is important to note that not all cases of bladder endometriosis require robotic assistance, and the decision to use robotic-assisted laparoscopy depends on the surgeon’s discretion and the individual patient’s condition.

Laparoscopic Excision

Laparoscopic excision is a minimally invasive surgical technique that involves making small incisions in the abdomen and inserting a laparoscope, which is a thin tube with a camera and surgical instruments. The surgeon uses the laparoscope to visualize and remove the endometrial lesions from the bladder wall. This method is effective for both superficial and deep lesions.

Pankaj Singhal, MD, MS, MHCM

Master Surgeon in Robotic Surgery

Dr. Pankaj Singhal, a globally recognized endometriosis surgeon, possesses over 25 years of expertise in laparoscopic excision surgery, enabling him to tackle even the most challenging endometriosis cases with confidence. Dr. Pankaj treats patients with diverse endometriosis-related conditions, ranging from ovarian endometriomas to severe deep infiltrating endometriosis that affects the bowels and other organs.

Dr. Pankaj prioritizes minimally invasive surgery and provides comprehensive personal care. Additionally, he is the owner and founder of New York Gynecology and Endometriosis (NYGE), and has dedicated his life to advocating for, respecting, and treating women suffering from this little-known disease. He is one of the few surgeons in the entire United States who have completed over 5,718 robot-assisted gynecologic surgeries.

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Surgeries are typically covered by health insurance. However, the extent of coverage can vary depending on the specific insurance plan and policy. Some insurance plans may cover a broad range of surgical procedures, including both elective and necessary surgeries, while others may have limitations or exclusions for certain procedures.

In some cases, certain insurance plans or programs may fully cover the cost of surgery, leaving the patient with no financial responsibility.

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