Department of Gynecological Sciences and Human Reproduction, University of Padova, Via Giustiniani 3, 35128 Padua, Italy.
Surg Endosc. 2012 Sep;26(9):2446-50. doi: 10.1007/s00464-012-2208-5. Epub 2012 Mar 10.
When endometriosis infiltrates more than 5 mm beneath the peritoneum it is called deeply infiltrating endometriosis and may involve the bladder. Only 1-2% of women with endometriosis have urinary involvement, mainly in the bladder. Resectoscopic transurethral resection alone is no longer recommended because of the surgical risks and recurrence. Usually surgeons prefer a laparotomy or laparoscopic approach depending on nodule localization and personal skill. We describe a new combined transurethral approach with Versapoint(®) and laparoscopic technique in the management of bladder endometriosis and the 12-month follow-up.
We performed a prospective observational study of 12 women affected by symptomatic bladder endometriosis at the University Hospital of Padova. We utilized a transurethral approach using a 5.2-mm endoscope with a 0.6-mm-diameter bipolar electrode (Gynecare Versapoint(®)). We delimited just the edges of the lesion via cystoscopy, penetrating transmurally at 3 or 9 o'clock without trespassing into the bladder peritoneum. Then, starting from the lateral bladder hole, we excised the lesion by laparoscopy with Harmonic ACE(®). The bladder hole was repaired with a continuous 3-0 monofilament two-layer suture.
Operating time ranged from 115 to 167 min and mean blood loss ranged from 10 to 200 ml. No conversion to laparotomy and no intraoperative complications occurred. No dysuria or hematuria were present at follow-up. There was one case of persistent suprapubic pelvic pain at the 12-month follow-up.
A combined transurethral approach with Versapoint(®) and laparoscopic treatment is a safe and easy technique for the management of bladder endometriosis, with low risks and good resolution of symptoms.
当子宫内膜异位症浸润超过腹膜下 5 毫米时，称为深部浸润性子宫内膜异位症，可能累及膀胱。只有 1-2%的子宫内膜异位症患者出现泌尿道受累，主要在膀胱。由于手术风险和复发，单独进行经尿道膀胱镜电切术不再被推荐。通常，根据结节定位和个人技能，外科医生更喜欢剖腹手术或腹腔镜手术。我们描述了一种新的联合经尿道入路，结合 Versapoint(®)和腹腔镜技术治疗膀胱子宫内膜异位症，并进行了 12 个月的随访。
我们在帕多瓦大学医院对 12 例患有症状性膀胱子宫内膜异位症的妇女进行了前瞻性观察研究。我们使用经尿道入路，使用直径 5.2 毫米、直径 0.6 毫米的双极电极（Gynecare Versapoint(®)）的内窥镜。我们通过膀胱镜检查限定病变的边缘，在 3 点或 9 点处穿透壁层，而不侵犯膀胱腹膜。然后，从侧膀胱孔开始，通过腹腔镜使用 Harmonic ACE(®)切除病变。膀胱孔用连续的 3-0 单丝双层缝线修复。
手术时间为 115-167 分钟，平均失血量为 10-200 毫升。无中转开腹，无术中并发症。随访时无尿痛或血尿。在 12 个月的随访中，有 1 例持续性耻骨上盆腔疼痛。
联合经尿道入路与 Versapoint(®)和腹腔镜治疗是一种安全且易于操作的治疗膀胱子宫内膜异位症的技术，风险低，症状缓解良好。
