Table of Contents Table of Contents
Previous Page  808 844 Next Page
Show Menu
Previous Page 808 844 Next Page
Page Background

Platinum Priority – Editorial

Referring to the article published on pp. 790–807 of this issue

Bladder Endometriosis: A Rare but Challenging Condition

Arnaud Fauconnier

a , b , * ,

Gabrielle Aubry




Xavier Fritel



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


offers a

valuable synthesis on this pathology. It is important to

highlight several key points of the management of this

challenging condition.

Multidisciplinary collaboration between urologists, radi-

ologists, and gynecologists is essential

[1] .

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

[1] .


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 ) [2] .

However, it

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

[3] .

Therefore, as suggested by Maggiore et al

[1] ,

a detailed

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

urinary symptoms


. 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 the

E 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 at


journal homepage:

DOI of original article:


* 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.

E-mail address:

(A. Fauconnier).



2017 Published by Elsevier B.V. on behalf of European Association of Urology.