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Endometriosis of the urinary tract

Nicola Berlanda, MD
Paolo Vercellini, MD
Luigi Fedele, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


Endometriosis is defined as the presence of endometrial glands and stroma at extrauterine sites. These ectopic endometrial implants are usually located in the pelvis, but can occur nearly anywhere in the body. Endometriotic lesions of the urinary tract are present in 1 to 2 percent of women with endometriosis [1].

Although ureteral and bladder endometriosis both occur in the urinary tract, they do not frequently coexist and their clinical presentation and management are different. Bladder endometriosis causes urinary discomfort often mimicking recurrent cystitis, but rarely results in severe sequelae. Ureteral endometriosis is often asymptomatic, but can lead to silent loss of renal function.

Diagnosis and management of urinary tract endometriosis are reviewed here. General principles of the treatment of endometriosis, as well as endometriosis of the rectovaginal septum, bowel, and thorax, are discussed separately. (See "Endometriosis: Treatment of pelvic pain" and "Endometriosis of bowel or rectovaginal space" and "Clinical features, diagnostic approach, and treatment of adults with thoracic endometriosis".)


There are three theories for the pathogenesis of endometriosis. These include spread of endometrial cells from retrograde menstruation, lymphatic or hematogenous dissemination, and coelomic metaplasia. Some experts have suggested that vesical endometriosis represents bladder adenomyosis or may be an extension of adenomyosis from the uterus due to anatomic proximity of the bladder and uterus or imperfect closure of the uterus during a cesarean delivery [2-6]. (See "Endometriosis: Pathogenesis, clinical features, and diagnosis", section on 'Pathogenesis' and "Uterine adenomyosis".)

Deep endometriosis is defined as a solid mass situated deeper than 5 mm under the peritoneum [7]. According to the theory of retrograde menstruation, deep endometriosis is the result of cells implanting in the most dependent areas of the pelvis, such as the spaces anterior and posterior to the uterus. These spaces serve as anatomic shelters that contain endometrial cells and prevent them from being cleared by the usual processes within the peritoneal cavity. The presence of endometrial cells elicits an inflammatory response and, eventually, a fibrotic nodule is originated and buried under the peritoneum.


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Literature review current through: Sep 2016. | This topic last updated: Mar 20, 2015.
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