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Platinum Priority – Review – Female Urology – Incontinence

Editorial by Arnaud Fauconnier, Gabrielle Aubry and Xavier Fritel on pp. 808–810 of this issue

Bladder Endometriosis: A Systematic Review of

Pathogenesis, Diagnosis, Treatment, Impact on Fertility,

and Risk of Malignant Transformation

Umberto Leone Roberti Maggiore

a , b ,

Simone Ferrero

a , b , * ,

Massimo Candiani

c ,

Edgardo Somigliana

d ,

Paola Vigano`


e ,

Paolo Vercellini



Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy;


Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics,

Maternal and Child Health, University of Genoa, Genoa, Italy;


Department of Obstetrics and Gynecology, Vita Salute San Raffaele University School of

Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy;


Department of Clinical Sciences and Community Health, Universita` degli Studi di Milano and

Department of Obstet-Gynecol, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;


Reproductive Sciences Laboratory, Division of

Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy


E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 9 0 – 8 0 7

available at


journal homepage:

Article info

Article history:

Accepted December 15, 2016

Associate Editor:

Jean-Nicolas Cornu







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The bladder is the most common site affected in urinary tract endometriosis.

There is controversy regarding the pathogenesis, clinical management (diagnosis and

treatment), impact on fertility, and risk of malignant transformation of bladder endome-

triosis (BE).


To systematically evaluate evidence regarding the pathogenesis, diagnosis,

medical and surgical treatment, impact on female fertility, and risk of malignant trans-

formation of BE.

Evidence acquisition:

A systematic review of PubMed/Medline from inception until

October 2016 was performed in accordance with the Preferred Reporting Items for

Systematic Review and Meta-analysis (PRISMA) statement and was registered in the

PROSPERO registry


CRD42016039281). Eighty-seven

articles were selected for inclusion in this analysis.

Evidence synthesis:

BE is defined as the presence of endometrial glands and stroma in the

detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to

its accuracy, safety, and cost. Clinical management can be conservative, using hormonal

therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen

combinations and progestogens should be chosen because of their favorable profile that

allows long-term therapy. Surgery should guarantee complete removal of the bladder

nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor

of segmental bladder resection. There is not a strong rationale for hypothesizing a

detrimental impact of BE per se on fertility. Furthermore, current evidence does not

support the removal of bladder endometriotic lesions because of the potential risk of

malignant transformation since this phenomenon is exceedingly rare.


BE is a challenging condition, and the common coexistence of other types of

endometriosis means that clinical management of BE should involve collaboration

between gynecologists and urologists.

Patient summary:

In this article we review available knowledge on bladder endometri-

osis. The review provides a useful tool to guide physicians in the management of this

complex condition.


2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

* Corresponding author. Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST,

Largo R. Benzi 10, 16132 Genoa, Italy. Tel. +39 01139 010511525; Fax: +39 01139 0108932843.

E-mail address:

(S. Ferrero).



2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.