Bladder Endometriosis Resolved by Robotic-Assisted Partial Cystectomy

This is a case report of a 31-year-old G1P1 with deep infiltrating endometriosis (DIE) of the bladder. She presented with bladder spasms, dysuria, and urinary frequency that worsened during her menses. On magnetic resonance imaging (MRI), she was found to have a 2.7 cm bladder dome mass and a 1.9 cm left-sided endometrioma. Biopsy of the bladder mass by urology was consistent with endometriosis. The patient failed medical management with Depo-Provera and GnRH antagonists and desired to proceed with surgical intervention. She ultimately underwent a robotic-assisted partial cystectomy for DIE of the bladder as well as ovarian cystectomy and excision of endometriosis in conjunction with gynecology and urology teams. The bladder endometriotic nodule was dissected circumferentially and the cystotomy was closed in two layers using absorbable 3-0 V-Loc. At her post-operative visit, the patient’s symptoms had significantly improved. This case demonstrates that deep infiltrating bladder endometriosis should be on the differential for patients presenting with cyclic pelvic pain and urinary symptoms. Medical management is a reasonable first step depending on imaging findings, symptoms, and fertility goals; but surgical management with partial cystectomy may be warranted.