Uro gynaecology- bladder endometriosis

1. Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical
College
Chennai 1

2. Professors:
 Prof. Dr. G. Sivasankar, M.S., M.Ch.,
 Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
 Dr. J. Sivabalan, M.S., M.Ch.,
 Dr. R. Bhargavi, M.S., M.Ch.,
 Dr. S. Raju, M.S., M.Ch.,
 Dr. K. Muthurathinam, M.S., M.Ch.,
 Dr. D. Tamilselvan, M.S., M.Ch.,
 Dr. K. Senthilkumar, M.S., M.Ch.
Dept Of Urology, KMC and GRH,
Chennai 2

3.  39 Yrs/f.
 C/O-Dysuria, increased frequency and
burning micturition-2months.
 No hematuria,no fever,no calcuria,
 No obstructive voiding symptoms
P/H- Peurperal sterilisation,no comorbid
illness.
Two children-normal delivery.
menstruation-normal.
Dept Of Urology, KMC and GRH,
Chennai 3

4.  P/A-no mass ,no bladder distension.
 E/G-meatus normal.
 P/V- normal .
Dept Of Urology, KMC and GRH,
Chennai 4

5.  Blood-Hb-10.2mg%,TC-6200,DC-P56L32E6
 Blood- sugar- 86mg, urea- 24mg,
creatinine-0.8mg.
 Urine-albumin,sugar,deposits-nil.
 Urine –culture-no growth.
 Urine-cytology-squamous epithelial cells,few
lymphocytes.
Dept Of Urology, KMC and GRH,
Chennai 5

6.  USG-Irregular polypoid growth at bladder
DOME size-3.1*2.6cm.
 CT KUB- Polypoid lesion 2.5*2cm fundus of
urinary bladder.
Perivescical fat plane –normal.
Bulky uterus.
Dept Of Urology, KMC and GRH,
Chennai 6

7. Dept Of Urology, KMC and GRH,
Chennai 7

8.  CYSTOSCOPY-3*4cm bluish nodular lesion in
bladder dome with broad base and normal
mucosa.
 PATIENT SUPINE-pfannelsteil incision is
made
 Bladder opened vertically.small bowel loops
adherent at dome of bladder.same released.
 Mass excised with a cuff of bladder.
 Bladder closed in two layers after placing spc.
Dept Of Urology, KMC and GRH,
Chennai 8

9. Dept Of Urology, KMC and GRH,
Chennai 9

10. Dept Of Urology, KMC and GRH,
Chennai 10

11. Dept Of Urology, KMC and GRH,
Chennai 11

12. Dept Of Urology, KMC and GRH,
Chennai 12

13.  DEFINITION-presence of functional
endometrial tissues in an ectopic site.
 COMMON SITES-ovaries,uterosacral
ligament,cul-de-sac,GIT,GUT,thorax.
 GENITOURINARY ENDOMETRIOSIS-
- 1% of endometriosis.
- More aggressive.
BLADDER-80-85%,URETER-15-20%
KIDNEY-RARE.
Dept Of Urology, KMC and GRH,
Chennai 13

14. -MIGRATORY THEORY retrogrademenstruation
and spillage through fimbria.
-METAPLASTIC THEORY-metaplasia of
peritoneal endothelial cells.
-EMBRYONIC THEORY-ectopic embryonic nests
from mullerian and wollfian ducts.
-IATROGENIC-from implantation during LSCS.
-Hematogenous and lymphatic spread.
Dept Of Urology, KMC and GRH,
Chennai 14

15. TYPES-Spontaneous and post LSCS.
CLINICAL FEATURES-
suprapubicpain,frequency,urgency,dysuria
cyclical hematuria(25%).
USG- discrete mass with slight thickened wall
with low level echoes.
IVU-honey comb appearance,filling defect.
Dept Of Urology, KMC and GRH,
Chennai 15

16. CYSTOSCOPY
-SUBEPITHELIAL-normal or bullous edema.
-EPITHELIAL-Bluish black submucosal nodules
at bladder dome or behind trigone.disappear
between menstruation.
-rarely malignant change-adeno carcinoma.
CT-cystic,solid or mixed dense mass.
MRI-low signal intensity with slight contrast
enhancement.
Dept Of Urology, KMC and GRH,
Chennai 16

17. Dept Of Urology, KMC and GRH,
Chennai 17

18. Dept Of Urology, KMC and GRH,
Chennai 18

19. MEDICAL-
OCP,androgen and derivatives-danazol,
GNRHagonists - leuprolide
Medroxyprogesterone,low dose oestrogen.
SURGICAL-PARTIAL CYSTECTOMY.
Pt completed family-partial cystectomy with TAH
with BSO.
Pt not completed family-partial cystectomy with
medical management.
Dept Of Urology, KMC and GRH,
Chennai 19

20. -EXTRINSIC-
-most common
-endometriosis in
periureteral tissues.
-IVU-filling defect.
-INTRINSIC-
-endometrial glands and
stroma within lamina
propria and
muscularis of ureter.
-IVU-segmental stricture.
Dept Of Urology, KMC and GRH,
Chennai 20

21. Dept Of Urology, KMC and GRH,
Chennai 21

22. TREATMENT-
-HYDRONEPHROSIS –
MILD and RFT-N-MEDICAL.
SEVERE and RFT-elevated-
future pregnancy-unilateral oopherectomy
withureterolysis.
No pregnancy-ureterolysis and TAH withBSO.
FAILS-distal ureterectomy with reimplantion.
Dept Of Urology, KMC and GRH,
Chennai 22

23. Dept Of Urology, KMC and GRH,
Chennai 23