Robotic-Assisted Resection of Bladder Endometriosis

INTRODUCTION: Bladder endometriosis is defined by the presence of endometriosis extending into the detrusor muscle. The most common presenting symptoms are lower urinary tract symptoms such as dysuria and hematuria, which may worsen with menstruation. Treatment may include expectant, medical, and surgical options and should be tailored to the individual patient. Partial cystectomy has been reported to be the preferred method for surgical management of bladder endometriosis, as it may decrease recurrence. Combined cystoscopy with laparoscopy may be used to best delineate the bladder lesion and preserve bladder mucosa. OBJECTIVE: The objective of this video is to review the incidence and presentation of bladder endometriosis and to demonstrate appropriate surgical treatment with robotic-assisted partial cystectomy. METHODS: This video describes a case of a 39-year-old G3P3003 with pelvic pain, dysuria, and heavy menstrual bleeding refractory to medical management and endometrial ablation. MRI was suggestive of stage IV endometriosis involving the anterior compartment and bladder. She underwent robotic-assisted total laparoscopic hysterectomy, bilateral salpingectomy, bilateral ovarian cystectomy, excision of endometriosis, cystoscopy, and partial bladder cystectomy. RESULTS: The procedure was performed without complication and the patient made appropriate postoperative progress. Cystogram was performed and the Foley catheter was removed on postoperative day 14. The patient reported resolution of her symptoms. CONCLUSIONS: Robotic-assisted partial cystectomy with combined cystoscopy was performed to excise bladder endometriosis and successfully treat dysuria and pelvic pain.