Takagi H, Matsunami K, Ichigo S, Imai A
Department of Obstetrics and Gynecology, Matsunami General Hospital, Gifu, Japan.
Clin Exp Obstet Gynecol. 2011;38(2):184-5.
Because of its low incidence, medical treatment of has not yet been well established although surgical excision is generally considered effective. We report the first case of primary bladder endometriosis successfully managed with a novel progestin dienogest.
A 39-year-old woman, nulligravida, presented with lower urinary tract symptoms, especially during menstruation. Cystoscopy, with subsequent cold cup biopsy, revealed a solitary submucosal mass (2 x 2 cm) in the bladder on the posterior wall; histopathology revealed the diagnosis of extraperitoneal endometriosis. MRI and laparoscopy confirmed no peritoneal endometriosis implants or adenomyosis. She was treated with oral 2 mg/day dienogest for six months. The measurable lesion exhibited a remarkable reduction in its size, accompanied with immediate relief of the lesion-related symptoms. At one year after medication cessation, she is well and symptom-free.
Dienogest may be a novel conservative alternative for bladder endometriosis, in particular for women who wish to avoid surgical intervention.
由于其发病率较低，尽管手术切除通常被认为有效，但子宫内膜异位症的医学治疗尚未得到很好的确立。我们报告了首例使用新型孕激素地诺孕素成功治疗的原发性膀胱子宫内膜异位症病例。
一名39岁未孕女性，出现下尿路症状，尤其是在月经期间。膀胱镜检查及随后的冷杯活检显示膀胱后壁有一个孤立的黏膜下肿块（2×2厘米）；组织病理学检查确诊为腹膜外子宫内膜异位症。磁共振成像（MRI）和腹腔镜检查证实无腹膜子宫内膜异位症植入物或子宫腺肌病。她接受了口服地诺孕素2毫克/天，为期6个月的治疗。可测量的病变大小显著减小，同时与病变相关的症状立即缓解。停药一年后，她情况良好且无症状。
地诺孕素可能是膀胱子宫内膜异位症一种新型的保守治疗选择，特别是对于希望避免手术干预的女性。
