June 30, 2022 | by Tamer Seckin, MD

Key Takeaways

• Pelvic endometriosis involves the growth of endometrial-like tissue on pelvic organs, including the peritoneum, bladder, rectum, and ureters.
• The exact cause of pelvic endometriosis remains unclear, with several theories proposed, including retrograde menstruation and altered immune responses.
• Diagnosis typically involves clinical evaluation, imaging techniques, and laparoscopic surgery, which is the gold standard for both diagnosis and treatment.
• Individualized treatment plans are essential, with laparoscopic deep excision surgery being the preferred method to remove lesions effectively.
• Complications such as hydronephrosis can occur if ureteral endometriosis is left untreated, potentially leading to kidney damage.

AI Summary

Pelvic endometriosis is a condition characterized by the presence of endometrial-like tissue on pelvic organs, leading to various symptoms, including chronic pelvic pain and urinary issues. The underlying causes are not fully understood, but several theories exist. Diagnosis is primarily achieved through laparoscopic surgery, which allows for both confirmation and treatment of the condition. Management strategies are tailored to the individual, often involving advanced surgical techniques to ensure effective removal of affected tissue and minimize recurrence risks. Early intervention is crucial to prevent complications such as kidney damage.

Pelvic endometriosis is endometriosis affecting the organs in the pelvic region. The pelvic region lies below the abdomen and comprises the bladder, rectum, ureters, peritoneum, and the organs of the female reproductive system.

What causes pelvic endometriosis?

The exact cause of pelvic endometriosis is not clear. Several theories exist to explain why endometrial cells translocate to different parts of the body. These include retrograde menstruation, altered gene regulation in stem cells, and a modified immune environment.

What are the types of pelvic endometriosis?

Pelvic endometriosis can affect the peritoneum, rectum, ureter, bladder, and kidneys.

Peritoneal endometriosis

The peritoneum is the thin, membranous layer of tissue that covers your abdominal wall and many of your organs. Doctors now recognize the peritoneum as a distinct organ. This is because of its key role in immunity and fluid drainage into the hemidiaphragm and thoracic area. Peritoneal endometriosis can affect various regions in the pelvic sidewall. The lesions may be typical or atypical in appearance. Doctors often fail to recognize peritoneal endometriosis, particularly in early-stage cases if the lesions are non-pigmented.

Rectal endometriosis

Rectal endometriosis often occurs with advanced disease. Symptoms often overlap with those of irritable bowel syndrome and include gas, bloating, alternating constipation & diarrhea, and/or dyschezia. However, the symptoms of rectal endometriosis usually coincide with menstruation. Surgery for deeply infiltrative rectal endometriosis can be difficult and doctors must develop an individualized approach for each patient. This approach can involve rectal shaving, disc excision, and/ or bowel resection.

Ureteral endometriosis

Ureteral endometriosis can affect one or both ureters, the tubes that connect the kidneys to the bladder. The disease may be intrinsic (inside the ureteral wall) or extrinsic (compression from outside the ureter). Symptoms include dysuria (pain while passing urine), back or flank pain, or hematuria. Other symptoms may be difficult to distinguish from pain due to other forms of pelvic endometriosis.

Rarely, the entire ureter can slowly become obstructed by disease, leading to hydronephrosis (dilation of the ureter) as urine has more difficulty passing into the bladder. Left untreated, this can lead to permanent damage to the kidney.

Surgical intervention is usually necessary to deal with both intrinsic and extrinsic forms of ureteral endometriosis.

Bladder endometriosis

Bladder endometriosis can also occur both inside and outside the bladder wall. It can cause pain with urination, urinary urgency, feelings of incomplete emptying, and excessive urinary frequency. These often coincide or are aggravated with the menstrual cycle. Imaging can help diagnosis and histological studies can confirm the presence of bladder endometriosis. Treatment depends upon disease severity, urinary symptoms, menstrual function, and fertility status.

How to best diagnose pelvic endometriosis?

Laparoscopic deep excision surgery followed by histological examination continues to be the gold standard for confirming the disease. Imaging techniques such as ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) may also aid diagnosis.

How to treat pelvic endometriosis?

Each type of pelvic endometriosis discussed above needs individualized surgical planning. Laparoscopic deep excision surgery with the aid of proper visualization techniques such as Aqua Blue Contrast (ABC) can help clearly identify and remove both superficial and deep pelvic endometrial lesions.

At Seckin Endometriosis Center, we recommend an initial consultation to discuss the best treatment plan for you. Depending on the severity of the disease, we may recommend a multidisciplinary approach with our urologic, colorectal, or cardiothoracic specialists.

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