Cruz Guerra Nicolás Alberto, Linares Quevedo Ana, Cuesta Roca Carmen, Clemente Ramos Luis, Castañeda Casanova Antonio
Servicio de Urología, Hospital Ramón y Cajal, Madrid.
Arch Esp Urol. 2002 Mar;55(2):194-7.
To describe a case of endometriosis of the urinary bladder in a patient with a previous history of cesarean section. Its possible relationship is discussed.
A 31-year-old female that had undergone cesarean section 8 years earlier is described. She had been referred by the gynecologist for further evaluation of a hyperechogenic area of about 2.5 cm in the posterior bladder wall. The patient had mild pollakiuria. Physical examination and analytical studies were normal except for microhematuria. CT suggested a possible uterine origin of the lesion. Endoscopic examination showed a lesion with a bullous appearance. Exploration and TUR with electrocoagulation of the bed were performed under anesthesia. Three small recurrences 0.5 cm in size were observed at 18 months' follow-up. TUR was repeated and the patient received complementary hormone therapy for 6 months.
Histopathological analyses of both TUR specimens demonstrated bladder endometriosis. At control evaluation 12 months after the second TUR, the patient is asymptomatic and the analytical and cystoscopic evaluation showed no significant findings.
There may be a possible relationship between some cases of endometriosis and previous cesarean section. Diagnosis is confirmed by histological analysis of tissue obtained by endoscopy. TUR and complementary hormone therapy is an alternative treatment option. The need for subsequent control follow-up is emphasized.
描述一例有剖宫产史患者的膀胱子宫内膜异位症病例，并探讨其可能的关联。
描述一名31岁女性，她8年前接受过剖宫产。她因膀胱后壁一个约2.5厘米的高回声区被妇科医生转诊进行进一步评估。患者有轻度尿频。除微量血尿外，体格检查和分析研究均正常。CT提示病变可能起源于子宫。内镜检查显示病变呈大疱状外观。在麻醉下进行探查及对创面行电凝经尿道切除术（TUR）。随访18个月时观察到3处0.5厘米大小的小复发灶。重复进行TUR，患者接受了6个月的辅助激素治疗。
两次TUR标本的组织病理学分析均证实为膀胱子宫内膜异位症。在第二次TUR后12个月的对照评估中，患者无症状，分析和膀胱镜检查未发现明显异常。
某些子宫内膜异位症病例与既往剖宫产之间可能存在关联。通过对内镜获取组织的组织学分析来确诊。TUR及辅助激素治疗是一种可供选择的治疗方案。强调了后续进行对照随访的必要性。
