Bladder endometriosis masquerading as recurrent urinary tract infection: successful fertility-preserving laparoscopic management

Abstract

Urinary tract endometriosis is an uncommon manifestation of deep infiltrating endometriosis, accounting for approximately 1% of all endometriosis cases, with the bladder being the most frequently involved urinary organ. Because its symptoms often mimic recurrent urinary tract infection or bladder pain syndrome, diagnosis is frequently delayed. A 38-year-old woman presented with recurrent dysuria, severe dysmenorrhea and urinary frequency for one year despite repeated medical treatment. Pelvic MRI demonstrated deep infiltrating endometriosis involving the posterior bladder wall with associated bilateral ovarian endometriomas, adenomyosis and rectosigmoid serosal involvement. Cystoscopy revealed a bluish submucosal lesion over the posterior bladder wall with sparing of the trigone. The patient underwent laparoscopic bilateral ovarian cystectomy, excision of deep infiltrating endometriosis, bilateral ureterolysis, adenomyomectomy and laparoscopic partial cystectomy with two-layer bladder repair. Histopathology confirmed bladder endometriosis. The postoperative course was uneventful, and urinary symptoms resolved following catheter removal and hormonal suppression with dienogest. Bladder endometriosis should be considered in women with persistent lower urinary tract symptoms refractory to conventional treatment, particularly when associated with pelvic pain or dysmenorrhea. Early MRI evaluation and multidisciplinary laparoscopic surgery allow complete excision while preserving fertility.