Bladder pain syndrome and endometriosis: the prevalence and multidisciplinary approach
Article authors
Moscow State University of Medicine and Dentistry, Dept, of Urology, Moscow, Russia
Introduction & Objectives
The endometriosis is the most common gynaecological cause of chronic pelvic pain (CPP) among pelvic adhesions, pelvic inflammatory disease, pelvic congestion syndrome and uterine leiomyoma. Until recently, the urinary bladder was not recognized as important generator of pelvic pain, and bladder pain syndrome/interstitial cystitis (BPS/IC) was not included in the differential diagnosis of CPP. Patients with endometriosis and BPS/IC complain of similar symptoms: cyclic pain associated with hormone fluctuation, perimenstrual or postcoital flaring, CPP and voiding symptoms. The aim of our study was to evaluate the relationship between BPS/IC and genital endometriosis.
Materials & Methods
Twenty two female patients (mean age 36 + 4.2) with CPP and presumptive diagnosis of endometriosis were undertaken a complex evaluation. Only 15 patients (68.2%) were noted voiding symptoms. Intensity of the pain and urgency were studied by visual analogue scales (VAS). Evaluation of symptoms severity and voiding problems was done using O'Leary-Sant IC Index.
Pelvic organ MRI was done in 4 cases (18.2%). All women underwent laparoscopy and cystoscopy under general anaesthesia, simultaneous procedure was done in 6 cases. Bladder and heterotopic lesion biopsies were taken and histological examinations were done.
Results
Endometriosis was confirmed in 21 patients from 22 (95.5%). BPS/IC was diagnosed in 47.6% of these women (10/21) on the basis of symptoms, cystoscopy and morphological results. The bladder wall involvement and foci of endometriosis inside the bladder was detected in two cases (2/21,9.52%). In one case TURB and nephroreterectomy was done due to upper urinary tract obstruction.
Conclusions
This study has demonstrated high prevalence of BPS/IC among the patients suffering endometriosis. In these patients the endometriosis may not be the single cause of the pain symptoms. The bladder may be a predominant pain source that is often underscored. Laparoscopic confirmation of endometriosis does not rule out BPS/IC. A work-up for CPP should include simultaneous assessment of bladder and an assessment for intraperitoneal pathology.
