Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.
Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.
Int Braz J Urol. 2023 Mar-Apr;49(2):202-210. doi: 10.1590/S1677-5538.IBJU.2022.0594.
Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning.
This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard.
We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1) Conclusion: DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.
膀胱子宫内膜异位症（BE）占泌尿道受累病例的 84%。术前评估中使用膀胱镜检查的应用受限。本研究旨在评估术前动态膀胱镜（DC）检查在接受深部子宫内膜异位症手术患者中的准确性，并描述主要发现及其对手术计划的影响。
这是一项横断面观察性研究，于 2011 年 1 月至 2022 年 3 月进行。根据受累深度将 DC 结果分为两组。为了评估敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），将膀胱受累的腹腔镜检查结果和组织病理学报告作为金标准。
本研究共纳入 157 例患者。41 例患者的 DC 结果异常。其中，39 例患者的异常结果在术中得到证实。该检测的敏感性和特异性分别为 58.21%和 97.78%。PPV 为 95.12%，NPV 为 75.86%。DC 中任何病变的存在对 BE 的诊断比值比（OR）为 61.28。2 型 BE 患者行部分膀胱切除术的比例高于 1 型病变患者（OR 9.72 CI 95% 1.9-49.1）。
DC 似乎是一种特异性高但敏感性低的检查方法。DC 异常与深部子宫内膜异位症治疗中更高的膀胱手术比例相关，而 2 型 BE 似乎与更大的膀胱切除术比例（9.72）相关。
