Platinum Priority – Editorial
Referring to the article published on pp. 790–807 of this issue
Bladder Endometriosis: A Rare but Challenging Condition
Arnaud Fauconniera , b , * ,
Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France;
Research Unit ‘‘Risk and
Safety in Clinical Medicine for Women and Perinatal Health’’, Versailles-Saint-Quentin University, Montigny-le-Bretonneux, France;
Poitiers University, University Hospital of Poitiers, Poitiers, France
Bladder endometriosis is a rare localization of deeply
infiltrating endometriosis (DIE). In this issue of
, the update by Paolo Vercellini’s team
valuable synthesis on this pathology. It is important to
highlight several key points of the management of this
Multidisciplinary collaboration between urologists, radi-
ologists, and gynecologists is essential .
In some cases, the
diagnosis is made first by the urologist to whom patients are
referred because of the presence of lower urinary tract
symptoms (LUTS) or on discovery of a urinary tract disease
on imaging. Endometriosis is a heterogeneous disease and
may present with various localizations, frequently with
digestive involvement. Therefore, as the authors note, a
thorough examination of the three pelvic compartment is
necessary, including gynecologic examination and reliable
imaging, before making any therapeutic decision .
therapeutic discussion should involve a multidisciplinary
team that must include a gynecologist experienced in
endometriosis. A fully comprehensive gynecological evalua-
tion is required, including questions regarding chronic pelvic
pain such as dyspareunia, severe dysmenorrhea, and
nonmenstrual pelvic pain. Because of the impact of
endometriosis on fertility, concerns about the patient’s
current or future fertility have to be addressed as these affect
the management plan, and in some cases immediate use of
assisted reproductive techniques may be required.
Understanding the relationships between LUTS and DIE
locations is challenging because the pathophysiological
mechanisms of symptoms are unclear and there is great
variability in the perception of symptoms and descriptions
between patients and in their interpretation by clinicians.
For bladder endometriosis, there is fair correlation between
LUTS and the location of the lesions as evaluated by imaging
or endoscopy or during surgery( Fig. 1 )  .
seems that there is no clear-cut relationship between pain
intensity and the magnitude of the disease, and symptoms in
some women may become independent of the disease itself .
Therefore, as suggested by Maggiore et al ,
evaluation of urinary symptoms and pain is essential to build
an efficient management plan. It also important to underline
that pain symptoms may sometimes persist as sequelae after
complete surgery; this phenomenon, which was brilliantly
demonstrated in the rat model of endometriosis, relates to
sensitization, which might be an important source of LUTS in
women with endometriosis
. This underlines the need to
treat chronic pain symptoms and their consequences in daily
life alongside the disease.
Sensitization may explain the link between bladder pain
syndrome and endometriosis, and urodynamics performed
in patients with bladder endometriosis has helped our
understanding of the mechanisms of pain and related
. As the review rightly states, when
the diagnosis of bladder endometriosis is known, there is no
indication for urodynamics, because this examination has
no impact on management
. Conversely, when urody-
namic studies are performed, nonspecific abnormalities
should lead clinicians to consider the diagnosis of endome-
triosis involving the bladder. Those performing urody-
namics must be aware of such cases, presenting as
functional or tumoral disorders, to avoid delayed diagnosis
or inappropriate management.
Surgical management of bladder endometriosis is
challenging. It is now clear that endometriosis of theE U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 8 0 8 – 8 1 0
available atwww.scienced irect.com
DOI of original article:http://dx.doi.org/10.1016/j.eururo.2016.12.015
* Corresponding author. Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 rue du
Champ Gaillard, 78300 Poissy Cedex, France. Tel. +33 1
39 27 52 51; Fax: +33 1 39274412.
2017 Published by Elsevier B.V. on behalf of European Association of Urology.