The effectiveness of an interdisciplinary approach to the diagnosis and treatment of endometriosis bladder lesions

Introduction. Deep endometriosis (DE) represents the most severe form of the disease, in which not only the reproductive system but also adjacent organs are affected, leading to serious complications. The urinary tract is the second most commonly involved system in deep endometriosis.

Objective. To study the clinical and anamnestic features of the course of deep infiltrating endometriosis with involvement of the bladder.

Materials & methods. A retrospective analysis was conducted of 114 patients undergoing surgical treatment for deep infiltrative endometriosis from three institutions placed in Ekaterinburg from 2021 to 2024. Patients were divided into two groups according to the presence (group 1, n = 30) or absence (group 2, n = 84) of involvement of the urinary bladder or the vesicouterine pouch.

Results. Symptom intensity prompting women to seek medical attention typically emerges from around 30 years of age. The interval between the first consultation for endometriosis-related complaints and the date of surgery was 11.6 [7.0; 37.1] months in group 1 and 13.1 [4.7; 31.5] months in group 2 (p = 0.450). The most frequent presenting symptom was chronic pelvic pain, observed in 66/114 (60.0%) patients overall: 27/30 (90.0%) in group 1 and 39/84 (46.4%) in group 2 (p = <0.001). LUTS were significantly more common in women with detrusor involvement in the endometriotic infiltrate: 14/30 (46.7%) in group 1 vs16/84 (19.0%) in group 2 (p = <0.001). Urinary symptoms usually manifested 1–2 days before the onset of menstruation or on the first day of bleeding. In all cases, the endometriotic infiltrate involved the posterior wall of the bladder body. Laparoscopic partial cystectomy was performed in 17/30 (50.0%) patients.

Conclusions. Women with deep endometriosis involving the bladder generally experience a more severe disease course. Bladder involvement in deep endometriosis is typically seen in the context of recurrent disease. When bladder endometriosis is suspected, careful evaluation of the posterior wall of the bladder body is particularly warranted.

1. Bezhenar VF, Linde VA, Kuzmina NS, Krylova NYu, Lyogonkaya AYu. Deep infiltrative endometriosis and fertility. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025;(4):22-28. (In Russian). DOI: 10.18565/aig.2025.1

2. Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, Saita E, Vercellini P. Mental health in women with endometriosis: searching for predictors of psychological distress. Hum Reprod. 2017;32(9):1855-1861. Facchin F, Barbara G, Dridi D, Alberico D, Buggio L, Somigliana E, Saita E, Vercellini P. Mental health in women with endometriosis: searching for predictors of psychological distress. Hum Reprod. 2017;32(9):1855-1861. DOI: 10.1093/humrep/dex249

3. Krasilnikova AK, Boyko EL, Malyshkina AI. Pathogenesis, diagnosis, and treatment of genital endometriosis: current state of the issue. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025;(3):22-29. (In Russian). DOI: 10.18565/aig.2024.301

4. Bolze PA, Paparel P, Golfier F. Localisations urinaires de l’endométriose. Résultats et modalités techniques de la prise en charge chirurgicale. RPC Endométriose CNGOF-HAS. Gynecol Obstet Fertil Senol. 2018;46(3):301-308. (In French). DOI: 10.1016/j.gofs.2018.02.016

5. Abrao MS, Andres MP, Miller CE, Gingold JA, Rius M, Neto JS, Carmona F. AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score. J Minim Invasive Gynecol. 2021;28(11):1941-1950.e1. DOI: 10.1016/j.jmig.2021.09.709

6. Signorile PG, Cassano M, Viceconte R, Marcattilj V, Baldi A. Endometriosis: a retrospective analysis of clinical data from a cohort of 4,083 patients, with focus on symptoms. In Vivo. 2022;36(2):874-883. DOI: 10.21873/invivo.12776

7. Barinov SV, Lazareva OV, Tirskaya YI, Kadtsyna TV, Tshulovsky YI, Khoroshkin YA, Shkabarnya LL, Ellert AN, Sidorina II. Clinical, anamnestic and diagnostic features of patients with different stages and localization of endometriosis. Ural Medical Journal. 2025;24(1):26-38. (In Russian). DOI: 10.52420/umj.24.1.26

8. Chapron C, Lang JH, Leng JH, Zhou Y, Zhang X, Xue M, Popov A, Romanov V, Maisonobe P, Cabri P. Factors and regional differences associated with endometriosis: a multi-country, case–control study. Adv Ther. 2016;33(8):1385-1407. DOI: 10.1007/s12325-016-0366-x

9. Song SY, Jung YW, Shin W, Park M, Lee GW, Jeong S, An S, Kim K, Ko YB, Lee KH, Kang BH, Lee M, Yoo HJ. Endometriosis-related chronic pelvic pain. Biomedicines. 2023;11(10):2868. DOI: 10.3390/biomedicines11102868

10. Wu CC, Chung SD, Lin HC. Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: a population-based study. Neurourol Urodyn. 2018;37(4):1413-1418. DOI: 10.1002/nau.23462

11. de Resende Júnior JAD, Crispi CP, Cardeman L, Buere RT, Fonseca MF. Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease. Int Urogynecol J. 2018;29(9):1349-1358. DOI: 10.1007/s00192-017-3531-0

12. Gabriel I, Vitonis AF, Missmer SA, Fadayomi A, DiVasta AD, Terry KL, Minassian VA. Association between endometriosis and lower urinary tract symptoms. Fertil Steril. 2022;117(4):822–830. DOI: 10.1016/j.fertnstert.2022.01.003

13. Piriyev E, Schiermeier S, Römer T. Bladder Endometriosis: Diagnostic, Therapy, and Outcome of a Single-Center Experience. Diagnostics. 2025;15(4):466. DOI: 10.3390/diagnostics15040466

14. Piriyev E, Schiermeier S, Römer T. Laparoscopic approach in bladder endometriosis, intraoperative and postoperative outcomes. In Vivo. 2023;37(1):357–365. DOI: 10.21873/invivo.13086

15. Piriyev E, Schiermeier S, Römer T. Laparoscopic approach in bladder endometriosis, intraoperative and postoperative outcomes. In Vivo. 2023;37(1):357–365. DOI: 10.21873/invivo.13086

16. Rocha MA, Mendes G, Castro LF, Mesquita S, Teixeira BL, Madanelo M, Vital JA, Marques-Monteiro M, Vinagre N, Oliveira B. Outcomes of Urinary Tract Endometriosis — Laparoscopic Treatment: A 10-Year Retrospective Study. J. Clin. Med. 2023;12(22): 6996. DOI: 10.3390/jcm12226996

17. Ceccaroni M, Clarizia R, Ceccarello M, De Mitri P, Roviglione G, Mautone D, Caleffi G, Molinari A, Ruffo G, Cavalleri S. Total laparoscopic bladder resection in the management of deep endometriosis: “take it or leave it.” Radicality versus persistence. Int Urogynecol J. 2020;31(8):1683-1690. DOI: 10.1007/s00192-019-04107-4

18. Oliveira MAP, Raymundo TS, Pereira TD, Souza RJd, Lima FV, De Wilde RL, Brollo LC, Robotic Surgery for Bladder Endometriosis: A Systematic Review and Approach. J. Clin. Med. 2023; 12(16): 5416. DOI: 10.3390/jcm12165416

19. Rousset P, Bischoff E, Charlot M, Grangeon F, Dubernard G, Paparel P, Lega JC, Golfier F. Bladder endometriosis: Preoperative MRI analysis with assessment of extension to ureteral orifices. Diagn Interv Imaging. 2021;102(4):255-263. DOI: 10.1016/j.diii.2020.11.011

20. da Silva FS Filho, Favorito LA, Crispi CP, Fonseca MF, de Resende JA Júnior. Dynamic cystoscopy to optimize preoperative assessment of bladder endometriosis. Int Braz J Urol. 2023;49(2):202-210. DOI: 10.1590/S1677-5538.IBJU.2022.0594

21. Knigin A.N. Interdisciplinarity: based problem. Tomsk State University Journal of Philosophy, Sociology and Political Science. 2008;(3):14-21. eLIBRARY ID: 12499835; EDN: KNNWUV