Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation [figure presented]

Research output: Contribution to journalArticle

Abstract

Context The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). Objective To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. Evidence acquisition A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. Evidence synthesis BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. Conclusions BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. Patient summary In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition. © 2016 European Association of Urology
Original languageEnglish
Pages (from-to)790-807
Number of pages18
JournalEuropean Urology
Volume71
Issue number5
DOIs
Publication statusPublished - 2017

Fingerprint

Endometriosis
Fertility
Urinary Bladder
Therapeutics
Progestins
Urinary Tract
PubMed
Registries
Meta-Analysis
Ultrasonography
Estrogens
Physicians
Safety
Costs and Cost Analysis
Recurrence

Keywords

  • Bladder
  • Diagnosis
  • Endometriosis
  • Fertility
  • Treatment
  • aromatase inhibitor
  • estrogen
  • gestagen
  • gonadorelin agonist
  • letrozole
  • norethisterone acetate
  • bladder disease
  • cancer risk
  • conservative treatment
  • cystalgia
  • cystectomy
  • cystoscopy
  • detrusor muscle
  • echography
  • endometriosis
  • endometrium
  • female fertility
  • health care cost
  • hormonal therapy
  • human
  • long term care
  • malignant transformation
  • meta analysis
  • nuclear magnetic resonance imaging
  • pathogenesis
  • priority journal
  • questionnaire
  • Review
  • safety
  • stroma
  • surgical technique
  • systematic review
  • transurethral resection
  • treatment planning
  • urodynamics

Cite this

@article{5b9e939b6c664686aebf6b9ed239b084,
title = "Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation [figure presented]",
abstract = "Context The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). Objective To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. Evidence acquisition A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. Evidence synthesis BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. Conclusions BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. Patient summary In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition. {\circledC} 2016 European Association of Urology",
keywords = "Bladder, Diagnosis, Endometriosis, Fertility, Treatment, aromatase inhibitor, estrogen, gestagen, gonadorelin agonist, letrozole, norethisterone acetate, bladder disease, cancer risk, conservative treatment, cystalgia, cystectomy, cystoscopy, detrusor muscle, echography, endometriosis, endometrium, female fertility, health care cost, hormonal therapy, human, long term care, malignant transformation, meta analysis, nuclear magnetic resonance imaging, pathogenesis, priority journal, questionnaire, Review, safety, stroma, surgical technique, systematic review, transurethral resection, treatment planning, urodynamics",
author = "{Leone Roberti Maggiore}, U. and S. Ferrero and M. Candiani and E. Somigliana and P. Vigan{\`o} and P. Vercellini",
note = "Cited By :4 Export Date: 30 October 2017 CODEN: EUURA Correspondence Address: Ferrero, S.; Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Largo R. Benzi 10, Italy; email: simoneferrero@me.com",
year = "2017",
doi = "10.1016/j.eururo.2016.12.015",
language = "English",
volume = "71",
pages = "790--807",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier B.V.",
number = "5",

}

TY - JOUR

T1 - Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation [figure presented]

AU - Leone Roberti Maggiore, U.

AU - Ferrero, S.

AU - Candiani, M.

AU - Somigliana, E.

AU - Viganò, P.

AU - Vercellini, P.

N1 - Cited By :4 Export Date: 30 October 2017 CODEN: EUURA Correspondence Address: Ferrero, S.; Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Largo R. Benzi 10, Italy; email: simoneferrero@me.com

PY - 2017

Y1 - 2017

N2 - Context The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). Objective To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. Evidence acquisition A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. Evidence synthesis BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. Conclusions BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. Patient summary In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition. © 2016 European Association of Urology

AB - Context The bladder is the most common site affected in urinary tract endometriosis. There is controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and risk of malignant transformation of bladder endometriosis (BE). Objective To systematically evaluate evidence regarding the pathogenesis, diagnosis, medical and surgical treatment, impact on female fertility, and risk of malignant transformation of BE. Evidence acquisition A systematic review of PubMed/Medline from inception until October 2016 was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and was registered in the PROSPERO registry (www.crd.york.ac.uk/prospero; CRD42016039281). Eighty-seven articles were selected for inclusion in this analysis. Evidence synthesis BE is defined as the presence of endometrial glands and stroma in the detrusor muscle. Ultrasonography is the first-line technique for assessment of BE owing to its accuracy, safety, and cost. Clinical management can be conservative, using hormonal therapies, or surgical. When conservative treatment is preferred, estrogen-progestogen combinations and progestogens should be chosen because of their favorable profile that allows long-term therapy. Surgery should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. There is not a strong rationale for hypothesizing a detrimental impact of BE per se on fertility. Furthermore, current evidence does not support the removal of bladder endometriotic lesions because of the potential risk of malignant transformation since this phenomenon is exceedingly rare. Conclusions BE is a challenging condition, and the common coexistence of other types of endometriosis means that clinical management of BE should involve collaboration between gynecologists and urologists. Patient summary In this article we review available knowledge on bladder endometriosis. The review provides a useful tool to guide physicians in the management of this complex condition. © 2016 European Association of Urology

KW - Bladder

KW - Diagnosis

KW - Endometriosis

KW - Fertility

KW - Treatment

KW - aromatase inhibitor

KW - estrogen

KW - gestagen

KW - gonadorelin agonist

KW - letrozole

KW - norethisterone acetate

KW - bladder disease

KW - cancer risk

KW - conservative treatment

KW - cystalgia

KW - cystectomy

KW - cystoscopy

KW - detrusor muscle

KW - echography

KW - endometriosis

KW - endometrium

KW - female fertility

KW - health care cost

KW - hormonal therapy

KW - human

KW - long term care

KW - malignant transformation

KW - meta analysis

KW - nuclear magnetic resonance imaging

KW - pathogenesis

KW - priority journal

KW - questionnaire

KW - Review

KW - safety

KW - stroma

KW - surgical technique

KW - systematic review

KW - transurethral resection

KW - treatment planning

KW - urodynamics

U2 - 10.1016/j.eururo.2016.12.015

DO - 10.1016/j.eururo.2016.12.015

M3 - Article

VL - 71

SP - 790

EP - 807

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 5

ER -