Bladder Endometriosis In A Woman Who Complains About Chronic Pelvic Pain And Periodic Hematuria

Öz

A 36 year old woman with 2 pregnancies which one of them is delivered by cesarean section 7 year ago and the other one was abortus applied for periodic hematuria (menuria) and chronic pelvic pain. Cystoscopy was performed and bladder mucosal biopsy was obtained because of suspicious bladder mass in abdominopelvic ultrasonography. Pathological diagnosis was bladder endometriosis. Gonadotrophin releasing hormon analog ( leuprolide asetat) treatment was used for 6 months. 2 months after therapy she applied again with pelvic pain. Diagnostic laparoscopy and second look cystoscopy was performed and regression of the endometriotic foci were seen. Pain and palpable mass out of pelvis may be a symptom of extrapelvic endometriosis although it is frequently asymptomatic. Urinary endometriosis is an unrecoverable disease, and collective approach of the gynecologist and urologist is necessary for treatment options. The severity of symptoms, spread of disease, probability of recurrences and cost of treatment shoud be considered and accurate modality of the treatment shoud be offered to the patient.

Anahtar Kelimeler

• pelvic pain,hematuria,endometirosis

Kronik pelvik ağrı ve siklik hematüri ile başvuran bir kadında mesanede endometriozis

Öz

Otuz altı yaşında, gebelik 2 doğum 1 abortus 1 ve 7 yıl önce sezeryan öyküsü bulunan hasta siklik hematüri (menüri) ve kronik pelvik ağrı yakınması ile başvurdu. Abdominopelvik ultrasonografide mesanede kitle şüphesiyle sistoskopi yapılarak biopsi alındı. Patolojik tanı mesanede endometriozis idi. Gonadotropin releasing hormon analoğu yakınması (leuprolide asetat) tedavisi 6 ay uygulandı. Tedaviden 2 ay sonra kasık ağrısı şikayeti ile tekrar başvurdu. Tanısal laparoskopi ve ikinci bakış sistoskopisi yapıldı ve endometriozis odaklarının regrese olduğu saptandı. Sıklıkla asemptomatik olsa da, ağrı ve pelvis dışında ele gelen bir kitlenin varlığı ekstrapelvik endometriozisin semptomları olabilir. Üriner endometriozis gibi sağaltımı zor bir hastalıkta tedavi basamaklarına kadın doğum ve üroloji uzmanları birlikte karar vermelidir. Yakınmaların şiddeti, hastalığın yaygınlığı, tekrarlama olasılığı ve tedavi maliyeti göz önüne alınarak doğru tedavi yöntemi hastaya önerilmelidir.

Anahtar Kelimeler

• pelvik ağrı,hematüri,endometriozis

Kaynakça

1. Referans1 Stopiglia RM, Ferreira U, Faundes DG, Petta CA. Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation. Int Braz J Urol 2016.
2. Referans2 Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol 2001;25:445,
3. Referans3 Donnez J, Spada F, Squifflet J, Nisolle M, Bladder endometriosis must be considered as bladder adenomyosis. Fertil Steril 2000;74:1175.
4. Referans4 Zugor V, Krot D, Rösch WH, Schrott KM, Schott GE, Endometriosis of the ureter and urinary bladder. Urologe A 2007;46:71.
5. Referans5 Kołodziej A, Krajewski W, Dołowy Ł, Hirnle L. Urinary Tract Endometriosis. Urol J 2015;12:2213-7.
6. Referans6 Manikandan R, Pollard A, Pritchard S, Adeyoju A. Vesical endometriosis. J Obstet Gynaecol 2004;24:327
7. Referans7 Westney OL, Amundsen CL, McGuire EJ. Bladder endometriosis: conservative management. J Urol 2000;163:1814.
8. Referans8 Vercellini P, Cortesi I, Crosignani PG, Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am J Obstet Gynecol 1996;175:396.

9. Referans9 Fedele L, Bianchi S, Viezzoli T,et al. Gestrinone versus danazol in the treatment of endometriosis. Fertil Steril 1989;51:781.
10. Referans10 Ke X, Qian H, Kang L, Wang J, Xie Y, Cheng Z. Clinical analyses of endometriosis after conservative surgery. Int J Clin Exp Med 2015;15;8(11):21703-6.