This is a surgical video presentation of laparoscopic excision of bladder endometriosis and partial cystectomy in a 33 year old female. This patient had a history of recurrent urinary tract infections and haematuria. A cystoscopy and biopsy confirmed a diagnosis of bladder endometriosis. Initial treatment with cystoscopy and diathermy ablation of endometriosis was unsuccessful and thus a laparoscopic excision of endometriosis and partial cystectomy was planned. It required careful pre operative planning, including a multi disciplinary team approach and a joint procedure with Urology and Gynaecology.
A laparoscopy showed a midline bladder nodule that was adherent to the uterus and a cystoscopy confirmed endometriosis was located at the dome of the bladder and extended close to but not involving the ureters. Firstly, bilateral ureteric stents were inserted cystoscopically by a Urologist. Then a laparoscopy was performed by a Gynaecologist, to adequately mobilise the bladder from the cave of Retzius and separate the bladder nodule from the lower uterus, cervix and vagina. The Urologist then demarcated the lesion with diathermy via cystoscopy to outline the disease free margin which ensured that there would be complete excision of endometriosis. A partial cystectomy was performed via laparoscopy to excise the full thickness of the bladder that contained endometriosis and then the bladder was closed under no tension in 2 layers.
An indwelling catheter remained in for 10 days and was removed after a cystogram. The ureteric stents were removed by the Urologist 6 weeks after the surgery. The patient had an uncomplicated post operative course and her symptoms resolved.
In addition, a review of the literature with respect to the diagnosis, management and outcomes of bladder endometriosis is included.