Department of Gynecology, Obstetrics II and Reproductive Medicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier Universitaire Cochin, Saint Vincent de Paul, Pavillon Lelong, 82 avenue Denfert Rochereau, 75014 Paris, France.
Hum Reprod. 2010 Apr;25(4):884-9. doi: 10.1093/humrep/deq017. Epub 2010 Feb 3.
Deep infiltrating endometriosis (DIE) is presented as a disease with high recurrence risk. Bladder DIE is the most frequent location in cases of urinary endometriosis. Surgical removal has been recommended for bladder DIE but long-term outcomes remains unevaluated. The objectives of this study are to evaluate the rate of recurrence after partial cystectomy for patients presenting with bladder DIE and to outline the surgical modalities for handling associated posterior DIE nodules.
Seventy-five consecutive patients with histologically proved bladder DIE were enrolled at a single tertiary academic center between June 1992 and December 2007. A partial cystectomy was performed for each patient. Complete surgical exeresis of all associated symptomatic DIE lesions was carried out during the same surgical procedure. Bladder DIE patients were classified into three groups: patients with isolated bladder DIE (Group A); patients with associated symptomatic posterior DIE (Group B); patients with associated asymptomatic posterior DIE (Group C). Bladder DIE recurrence was defined as a clinical reappearance of the disease or radiological evidence that mandated a new surgical procedure. We assessed pelvic pain symptoms pre- and post-operatively using a 10-cm visual analogue scale.
In a series of 627 patients with DIE, we observed 75 patients (12%) with bladder DIE. With a 50.9 +/- 44.6 months mean follow-up after partial cystectomy no patient presented evidence of bladder DIE recurrence. Post-operatively, we observed a significant improvement with respect to pain symptoms, with only two patients (2.7%) developing major complications during follow-up. Among patients with non-operated associated asymptomatic posterior DIE lesions (n = 15), a second surgical procedure indicated for pain symptoms was necessary in only one patient (6.7%).
For patients presenting with bladder DIE, no patients required further surgery for bladder recurrence after radical surgery consisting in partial cystectomy. Exeresis of associated posterior DIE nodules is indicated only when they are symptomatic.
深部浸润性子宫内膜异位症（DIE）表现为一种复发风险高的疾病。膀胱 DIE 是尿路上皮内异症最常见的部位。对于膀胱 DIE，已推荐手术切除，但长期疗效仍未得到评估。本研究的目的是评估膀胱 DIE 患者行部分膀胱切除术的复发率，并概述处理相关后位 DIE 结节的手术方式。
1992 年 6 月至 2007 年 12 月，在一家单中心的三级学术机构共纳入 75 例经组织学证实的膀胱 DIE 患者。每位患者均行部分膀胱切除术。在同一手术过程中，对所有相关症状性 DIE 病变进行完全切除。根据是否存在相关症状，将膀胱 DIE 患者分为三组：单纯膀胱 DIE 患者（A 组）、伴有相关症状性后位 DIE 患者（B 组）和伴有无症状性后位 DIE 患者（C 组）。膀胱 DIE 复发定义为疾病的临床再现或影像学证据表明需要新的手术治疗。我们使用 10cm 视觉模拟量表评估术前和术后的盆腔疼痛症状。
在一组 627 例 DIE 患者中，我们观察到 75 例（12%）患有膀胱 DIE。在部分膀胱切除术后平均 50.9±44.6 个月的随访中，无患者出现膀胱 DIE 复发的证据。术后，疼痛症状明显改善，仅 2 例（2.7%）患者在随访期间出现严重并发症。在未行手术治疗的无症状性后位 DIE 病变患者中（n=15），仅 1 例（6.7%）因疼痛症状需要进行第二次手术。
对于患有膀胱 DIE 的患者，在根治性手术（部分膀胱切除术）后，无患者因膀胱复发而需要进一步手术。仅当相关后位 DIE 结节出现症状时，才需要切除。
