CLINICAL PRESENTATION AND DIAGNOSIS OF URINARY TRACT ENDOMETRIOSIS

Objective. To study the specific features of the clinical presentation and diagnosis of urinary tract endometriosis. Subject and methods. Data on the patients examined and operated on in the period February 2010 to January 2013 were considered. The patients’ complaints, the data of physical and instrumental studies (transvaginal ultrasound, renal and bladder ultrasonography (USG), small pelvic and renal magnetic resonance imaging (MRI), cystoscopy), intraoperative findings, and histological examination were analyzed. Results. Thirty-four patients were diagnosed with endometriosis in the bladder (n = 17 (50%), in the ureters (n=12 (35.3%), and in the bladder and ureters (n = 5 (14.7%). Urologic symptoms were noted in 8 (17%) patients with bladder endometriosis and in 4 (12%) patients with ureteric involvement. Insignificant cyclic dysuresis was characteristic. USG was of informative value in 4 and 5 cases of bladder and ureteric endometriosis, respectively. MRI revealed bladder endometroid infiltrates 1 cm in diameter in 6 patients and ureteric ones in 12 women, including 5 with hydronephrotic renal changes. Cystoscopy demonstrated bladder endometroid infiltrate in 6 patients and ureteric stenting in 5. Conclusion. Analysis of the findings may suggest that the absence of symptoms is not an indicator for that of the disease and their magnitude is not indicator for disease activity. The timely diagnosis of infiltrative urinary tract endometriosis requires the work congruence of three components: 1) physician and patient awareness; 2) interaction between specialists (a gynecologist, an urologist); 3) targeted examination.

urinary tract endometriosis, bladder endometriosis, ureteric endometriosis, diagnosis, diagnosis of urinary tract endometriosis