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N44 The value of combined transurethral resection and adjuvant hormonal therapy in treatment of bladder endometriosis

      Introduction and Objectives

      Endometriosis affects 1–2% of menstruating women and up to 20% women after surgical pelvic operations. Most cases occur between 25–45 yrs. The peak incidence is around 30–40 yrs. Involvement of the urinary tract is seen in about 1% cases of this disease.

      Material and Methods

      Since 1983 till 2008 seven female patients (age 32–46 yrs, mean age 37.6yrs) initially referred as bladder tumor underwent trans urethral resection. Histopathological examination revealed endometriosis of the urinary bladder. Clinical data are presented in the table I. The patients were followed-up with US and cystoscopy.
      Tabled 1
      Case, Initials, Age (y)SymptomsUS-ScanTreatmentResults/follow-up
      1, ZG, 32HematuriaNot performedTURBT, hormonalAsymptomatic during 276 months
      2, ON, 32HematuriaBladder tumorTURBT. Partial resection of the bladder, hormonalAsymptomatic 204 months
      3, KB, 32recurrent flank painParavesical tumor compressing lower ureterTURBT Nephrectomy hormonalAsymptomatic 204 months
      4, KM, 40asymptomaticBladder tumorTURBT, hormonalAsymptomatic 120 months
      5, SA, 40asymptomaticBladder tumorCystectomy hormonalAsymptomatic 84 months
      6, GA, 46dysuriaBladder tumorTURBTDied 4 months later (Stroke)
      7, WM, 46dysuriaBladder tumorTURBT Hormonal.Asymptomatic 6 Months later

      Results

      Histopathological examination revealed endometriosis of the urinary bladder. 6 out of 7 patient underwent adjuvant personally tailored hormonal treatment. Good results we achieved in all cases, after combined (surgical and hormonal) treatment in 6 cases and in 1 case after surgical treatment only. One patient died 4 months post TURT of stroke. Mean follow up was 128 months.

      Conclusions

      TURBT with adjuvant hormonal treatment of bladder endometriosis permits to achieve good long term results in all cases. No neoplastic transformation was observed during the follow-up.