Bladder endometriosis: Conservative management

Purpose: We evaluate the characteristics of women with bladder endometriosi s successfully treated with hormonal therapy. Materials and Methods: The records of 14 patients with a mean age of 48.7 y ears (range 26 to 71) diagnosed with bladder endometriosis on cystoscopic e valuation were reviewed for presenting complaints, findings and response to therapy. Results: The most frequent presenting complaints were urgency (78%), freque ncy (71%), suprapubic pain (43%), urge incontinence (21%) and dyspareunia ( 21%). Of the patients 86% did not have a history of recurrent urinary tract infections, 6 (42%) had a history of endometriosis, including 3 who were p reviously treated with hysterectomy/oophorectomy and 8 (57%) were on some f orm of therapy for estrogen deficiency. Tn all patients endometrial implant s were identified on cystoscopic examination. In 2 patients the endometriom a correlated to lesions on the serosal surface of the bladder during laparo scopic evaluation. Of the patients 13 were treated either with low dose ora l contraceptives, decrease or elimination of the estrogen component of the present regimen or addition of progesterone to therapy, and 12 (92%) report ed sustained improvement of symptoms at a mean of 18.6 months (range 8 to 2 4). Conclusions: In more than 70% of cases the presenting symptoms of bladder e ndometriosis are identical to those of interstitial cystitis. Therefore, en dometriosis should always be considered in the patient referred for frequen cy, urgency and pain with no documented infection. Hormonal therapy is reas onable and effective management for bladder endometriosis. This option pres erves fertility, making it especially attractive to younger women.