Endometriosis of the urinary tract includes endometrial tissue located in or around the bladder, ureters, urethra, or kidney. It is classified as extragenital endometriosis and affects up to12% of endometriosis cases. Urinary endometriosis can lead to silent kidney failure if not treated on time. In terms of the most frequently affected part, bladder is the most affected followed by ureteral endometriosis.
What is endometriosis of the urinary tract
Urinary tract endometriosis occurs when endometriosis is found on the surface or deep inside the wall of the urinary bladder or the urethra.
Urinary tract endometriosis can be superficial endometriosis and deep endometriosis. Deep urinary endometriosis is defined by the invasion of endometrial-like glands and stroma at least 5 mm beneath the peritoneal surface.
Urinary tract endometriosis symptoms
Depending on the affected organ, urinary tract endometriosis can be symptomatic or asymptomatic.
Compared to bladder endometriosis, ureteral endometriosis is usually silent, with no apparent urinary symptoms, making the diagnosis of ureteral endometriosis even more difficult. Most patients, however, present with the usual symptoms of endometriosis, such as pelvic pain and dysmenorrhea. Also, some patients may have hematuria, or flank pain.
Bladder endometriosis
Endometriosis of the bladder can be superficial or deep. Deep bladder endometriosis is defined by the presence of endometriosis tissue invading the detrusor muscle of the bladder. This can be either full thickness or partial thickness.
Ureteral endometriosis
Endometriosis of the ureters endometriosis can affect one or both ureters, but the left ureter is most commonly affected.
Ureteral endometriosis can be intrinsic or extrinsic endometriosis. In extrinsic endometriosis tissues are found on the surface, and in intrinsic endometriosis, tissues may infiltrate the muscle, lamina propria, and ureteral lumen, leading to proximal dilatation of the ureter with stricture.
Infiltrative endometriosis of the ureters is much rarer than bladder endometriosis. In many cases, this type of endometriosis results from the extension of the disease/nodules affecting the uterosacral ligaments. This means that frequently the ureter itself is not infiltrated by endometriosis, but is surrounded by fibrotic tissue caused by infiltrative endometriosis of the adjacent uterosacral ligament.
