ABSTRACT
Purpose
Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning.
Materials and Methods
This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard.
Results
We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1)
Conclusion
DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.
Endometriosis; Urinary Bladder; Cystoscopy
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1A) Illustration demonstrating the procedure, which consists of a conventional cystoscopy associated with vaginal palpation. 1B) Vaginal palpation (dashed line) allows to identify and delimit a deep lesion in the bladder (type 1 lesion), nontender and fixed, which could go unnoticed as a roughness in its wall in a conventional cystoscopy.
Dynamic cystoscopy (DC) evidencing BE type 1, a nodule adhered to the bladder wall, without mucosal involvement (arrow). B) Laparoscopic view of the anterior compartment of the female pelvis. Minor bladder involvement in the peritoneal surface of the bladder (arrow). C) Treatment of BE in a more conservative resection- bladder shaving (arrow). D, E, F) -thirty three- year patient with BE involving bladder mucosa. D) DC evidencing BE type 2, an infiltrative lesion involving bladder mucosa with a typical blush mass (arrow). E) Laparoscopic view of the anterior compartment of the female pelvis with extensive adhesions and endometriotic lesions on the surface of the bladder (arrow) F) Treatment of BE: partial cystectomy, with opening of the mucosa (arrow).
