Many women who suffer from endometriosis may not realise that the disease can affect the urinary tract.
How common does endometriosis affect the urinary tract and where?
The exact incidence is unclear but may occur in 1 -4% of all cases of endometriosis. The sites where endometriosis occurs are the bladder and the ureter.
What are the symptoms of urinary tract endometriosis?
Women with urinary tract endometriosis have few or no symptom. Some present with infertility. Others experience urgency, frequency, pain on passing urine, in the flank or the back, recurrent urinary tract infections. Some women see blood in urine at times of menstruation. Other women give a history of having had surgery including hysterectomy for endometriosis many years prior.
How can urinary tract endometriosis by diagnosed?
Like bowel endometriosis, diagnosis of urinary tract endometriosis requires a careful history and thorough physical examination. The detection of tender “nodule” at the top of the vagina adjacent to the bladder is uncommon is uncommon.
Ultrasound may show the presence of a bladder “nodule”. CT scan and XR may diagnose ureteric obstruction and / or swollen kidney. Cystoscopy and laparoscopy are fundamental to the assessment of urinary tract endometriosis.
What treatments are available for urinary tract endometriosis?
The treatment options generally follow the same principles outlined in the CARE Endometriosis brochure. While medical therapy is effective for pain relief, symptoms often recur once treatment is completed.
What is the role of surgery for urinary tract endometriosis?
Surgery is indicated if fertility is a major goal, where symptoms fail to respond to medical therapies, or where ureteric obstruction has been confirmed. Untreated ureteric obstruction may lead to irreversible kidney damage.
As in bowel endometriosis, endometriosis of the urinary tract represents the severe end of the disease spectrum. Optimal management requires a team of specialists working together to thoroughly assess the risks and benefits of treatments and to determine the optimal care.
At CARE, we specialise in endoscopic management of severe endometriosis. Our multidisciplinary team includes specialist nurse educator, gynaecologists, colorectal surgeons (Dr Justin Evans, A/Professor M Schitzler, Dr Steve Pilinger), and urologists ( Dr G Coombs, Dr J Vass).