Urinary tract endometriosis: Systematic review

Objective: To systematically evaluate the epidemiology, diagnostic modalities, and treatment strategies for urinary tract endometriosis (UE), with the goal of informing evidence-based clinical practice. Materials and methods: A comprehensive search of PubMed, Ovid, Embase, MEDLINE, and the Cochrane Library was conducted from January 1976 to March 2023. The protocol was registered with INPLASY (INPLASY202420054). Original studies reporting clinical, diagnostic, or therapeutic aspects of urinary tract endometriosis (UE) involving the bladder, ureter, kidney, or urethra were included, while reviews, editorials, and duplicate publications were excluded. Three reviewers independently screened articles, extracted relevant data, and categorized findings by site of involvement and diagnostic or treatment modality. A narrative synthesis of the results was performed. Results: A total of 137 studies were included. Bladder endometriosis was the most common subtype (80%–85%), followed by ureteral involvement (9%–23%). MRI and transvaginal ultrasound showed the highest sensitivity and specificity for diagnosis. Minimally invasive surgery, particularly robotic-assisted laparoscopy, was associated with favorable outcomes and lower recurrence rates. Conclusion: UE is a rare and underdiagnosed manifestation of deep infiltrating endometriosis. Early recognition with appropriate imaging and multidisciplinary surgical planning improves outcomes. Larger prospective studies are needed to inform standard guidelines.