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Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation.

Abstract

CONTEXT

The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE).

OBJECTIVE

To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE.

EVIDENCE ACQUISITION

A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis.

EVIDENCE SYNTHESIS

BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare.

CONCLUSIONS

BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists.

PATIENT SUMMARY

In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.

    ,

    Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy. Electronic address: simoneferrero@me.com.

    ,

    Department of Obstetrics and Gynecology, Vita Salute San Raffaele University School of Medicine, IRCCS, Ospedale San Raffaele, Milan, Italy.

    ,

    Department of Clinical Sciences and Community Health, Università degli Studi di Milano and Department of Obstet-Gynecol, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

    ,

    Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy.

    Department of Clinical Sciences and Community Health, Università degli Studi di Milano and Department of Obstet-Gynecol, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

    Source

    European urology 71:5 2017 05 pg 790-807

    MeSH

    Aromatase Inhibitors
    Cell Transformation, Neoplastic
    Contraceptives, Oral, Combined
    Cystectomy
    Cystoscopy
    Endometriosis
    Female
    Gonadotropin-Releasing Hormone
    Humans
    Infertility, Female
    Progestins
    Ultrasonography
    Urinary Bladder
    Urinary Bladder Diseases
    Urologic Surgical Procedures

    Pub Type(s)

    Journal Article
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    28040358

    Citation

    Leone Roberti Maggiore, Umberto, et al. "Bladder Endometriosis: a Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact On Fertility, and Risk of Malignant Transformation." European Urology, vol. 71, no. 5, 2017, pp. 790-807.
    Leone Roberti Maggiore U, Ferrero S, Candiani M, et al. Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol. 2017;71(5):790-807.
    Leone Roberti Maggiore, U., Ferrero, S., Candiani, M., Somigliana, E., Viganò, P., & Vercellini, P. (2017). Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. European Urology, 71(5), pp. 790-807. doi:10.1016/j.eururo.2016.12.015.
    Leone Roberti Maggiore U, et al. Bladder Endometriosis: a Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact On Fertility, and Risk of Malignant Transformation. Eur Urol. 2017;71(5):790-807. PubMed PMID: 28040358.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. AU - Leone Roberti Maggiore,Umberto, AU - Ferrero,Simone, AU - Candiani,Massimo, AU - Somigliana,Edgardo, AU - Viganò,Paola, AU - Vercellini,Paolo, Y1 - 2016/12/28/ PY - 2016/10/24/received PY - 2016/12/15/accepted PY - 2017/1/4/pubmed PY - 2018/2/13/medline PY - 2017/1/2/entrez KW - Bladder KW - Diagnosis KW - Endometriosis KW - Fertility KW - Treatment SP - 790 EP - 807 JF - European urology JO - Eur. Urol. VL - 71 IS - 5 N2 - CONTEXT: The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). OBJECTIVE: To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. EVIDENCE ACQUISITION: A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. EVIDENCE SYNTHESIS: BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. CONCLUSIONS: BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. PATIENT SUMMARY: In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/28040358/Bladder_Endometriosis:_A_Systematic_Review_of_Pathogenesis_Diagnosis_Treatment_Impact_on_Fertility_and_Risk_of_Malignant_Transformation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(16)30919-8 DB - PRIME DP - Unbound Medicine ER -