Bladder and Ureter Endometriosis

Bladder endometriosis

Bladder endometriosis most often involves the bladder dome or the posterior wall. Lesions may be superficial (on the serosal surface), or full-thickness, invading the bladder muscle and mucosa.

Common bladder symptoms

• Suprapubic pain around menstruation
• Painful urination (dysuria)
• Urinary urgency and frequency
• Blood in the urine around menstruation (cyclic hematuria)
• Recurrent urinary symptoms with negative urine cultures

Surgical options for bladder disease

• Shaving of superficial serosal disease
• Partial cystectomy — full-thickness excision of the involved bladder wall with primary repair
• Bladder catheter for a defined healing period after full-thickness repair

Ureteral endometriosis

The ureter is the tube that carries urine from the kidney to the bladder. Endometriosis can affect the ureter in two ways:

• Extrinsic: disease compresses the ureter from outside, often from uterosacral or pelvic sidewall lesions
• Intrinsic: disease invades the ureter wall itself

Why ureteral involvement is dangerous

Ureteral obstruction can develop silently. Urine cannot drain freely from the kidney, causing hydronephrosis (kidney swelling) and, if prolonged, loss of kidney function. Some patients have no urinary symptoms at all until the kidney is already affected. This is a key reason endometriosis mapping includes evaluation of the ureters and kidneys.

Symptoms that may suggest ureteral involvement

• Flank pain
• Signs of urinary obstruction on imaging
• Hydronephrosis found incidentally
• Often no symptoms at all

Surgical options for ureteral disease

• Ureterolysis: freeing the ureter from surrounding endometriosis (used for extrinsic disease)
• Ureteral resection with reanastomosis: removing the affected segment and reconnecting the healthy ends
• Ureteral reimplantation into the bladder: used when the distal ureter is involved and reanastomosis is not appropriate
• Temporary ureteral stent: commonly placed to protect healing after ureteral surgery

Pre-operative imaging and planning

MRI and endometriosis-protocol ultrasound help evaluate bladder and ureter involvement. Additional urologic studies (renal ultrasound, cystoscopy, or CT urogram) may be added to define anatomy and kidney drainage. See MRI & Ultrasound Mapping.

Why urologic collaboration matters

Bladder and ureter endometriosis surgery is best performed by an experienced endometriosis surgeon with a urologist or urogynecologist available in the same operating room. Advance planning, appropriate stents, and post-operative imaging follow-up help protect kidney function long-term. See Multidisciplinary Team.

Follow-up

Patients who have had ureteral surgery typically have follow-up imaging to confirm normal drainage. Long-term monitoring, hormonal support when appropriate, and specialist review support the best long-term outcome.