Bladder endometriosis: deep infiltrating endometriosis or adenomyosis?

Objective: To describe the anatomopathologic characteristics of endometriosis infiltrating the bladder detrusor. Design: Descriptive anatomopathologic study. Setting: Tertiary care center for endometriosis. Patient(s): Four patients, aged 22-38 years, who underwent laparotomy for bladder endometriosis. Intervention(s): Surgical excision and pathologic analysis of bladder endometriotic nodules in four patients. Main Outcome Measure(s): Gross and microscopic characteristics of endometriotic nodules. Result(s): A nodule of adenomyosis on the anterior wall of the uterus, in continuity with the detrusor lesion, was excised in three patients. In the other patient, bladder endometriosis was continuous with a nodule that infiltrated the left parametrium and extended as far as the posterior leaf of the ipsilateral broad ligament. Microscopically, all of the lesions had a similar histologic pattern: foci of endometriosis scattered in the bladder wall. The main feature was the paucity of endometrial-type stroma, particularly in the bladder submucosa, where glands were almost always dilated and cystlike and were lined by flattened cells. Conclusion(s): Analysis of our patients, although it does not pinpoint the pathogenesis of the disease, seems to exclude the hypothesized intraperitoneal origin of endometriotic lesions of the bladder detrusor. (C) 1998 by American Society for Reproductive Medicine.