膀胱鏡を併用し腹腔鏡下に膀胱部分切除術を施行した膀胱子宮内膜症の2例

抄録

  Bladder endometriosis is a rare pelvic dysfunction with painful urination and hematuria.

  We successfully managed two cases of bladder endometriosis by cystoscopy-assisted laparoscopic partial cystectomy.

Case 1: A 40-year-old woman presented with urodynia during menstruation for four years. Cystoscopy revealed a dark-red polypoid lesion on the posterior bladder wall. She underwent hormonal therapy with GnRH-agonist for six months followed by dienogest for a few months. She finally decided to undergo an operation because of poor improvement of symptoms. Incision line was determined using cystoscopy with a margin from both ureteral orifices and then laparoscopic partial cystectomy was performed. She was discharged after confirmation of no leakage by cystography at post-operative day 7.

Case 2: A 44-year-old woman was diagnosed with endometriosis at the age of 30 and had been taking low dose estrogen and progestin (LEP). She discontinued LEP owing to breast cancer and then started to feel pain during menstruation, urination, and defecation. Cystoscopy revealed a polypoid lesion on the posterior bladder wall. She underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and cystoscopy-assisted partial cystectomy. Her postoperative course was uneventful, and she was discharged at post-operative day 8. Altogether, this case report suggests that using cystoscopy to avoid unnecessary ureterovesicostomy and maintaining adequate distance from both ureteral orifices is useful to determine the incision line. Cooperation with urologists is necessary when performing surgery in patients with bladder endometriosis.