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Surgical Endoscopy

Published in:

01-09-2012

Combined transurethral approach with Versapoint^® and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up

Authors: Pietro Litta, Carlo Saccardi, Giulia D’Agostino, Pasquale Florio, Luca De Zorzi, Massimo Dal Bianco

Published in: Surgical Endoscopy | Issue 9/2012

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Title: Combined transurethral approach with Versapoint® and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up
Authors: Pietro Litta
Carlo Saccardi
Giulia D’Agostino
Pasquale Florio
Luca De Zorzi
Massimo Dal Bianco
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 9/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2208-5

At a glance: The STEP trials

Springer Medicine

Combined transurethral approach with Versapoint^® and laparoscopic treatment in the management of bladder endometriosis: technique and 12 months follow-up

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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