Particulars of Anatomical and Morphological Lesion of Bladder With Endometriosis and the Choice of Treatment Method

ANNOTATION. The work investigates the efficacy of using modern methods of study and treatment of some atypical anatomical and morphological lesions of bladder with endometriosis. The study was conducted in two patients with an atypical anatomical and morphological endometriosis of the urinary bladder. In the first case, patient S., aged 38 years, was hospitalized in the urology department on 17.04.2018 with complaints of pain in the area of the right kidney, chronic pelvic pain, and dysuria. Based on the objective examination, MRI of the pelvic organs, CT scan of the kidneys with contrast enhancement and cystoscopy, a diagnosis was established: bladder neoplasm involving the intramural part of the right ureter and stage II ureterohydronephrosis of the right kidney. The patient underwent surgical intervention — resection of the bladder wall with the neoplasm, resection of the lower half of the right ureter and imposition of ureterocystoanastomosis in the reposed area of the bladder using the Psoas hitch method. During histological examination, areas of endometrioid stroma and endometrioid glands were found in the muscle tissues of the sections. In the second case, patient S., aged 41 years, was hospitalized in the urology department on 21.05.2021 with complaints of chronic pelvic pain, pronounced dysuria and nocturia. Treatment of this patient in an outpatient setting with a diagnosis of chronic cystitis for two years was ineffective. During cystoscopy, pronounced bullous edema was revealed on the posterior wall of the urinary bladder above the interureteric crest. A biopsy of the mucous membrane did not reveal a tumor process. The patient underwent transurethral electroresection of the affected area with a cut in the area of muscle tissue resection. During histological examination, areas of endometrioid stroma and endometrioid glands were found in the muscle tissues of the sections. After surgery, the patient underwent a course of conservative treatment with the hormonal progestin-based drug Dienogest for 10 months. When both patients were examined in one year after the end of conservative treatment, there were no clinical or ultrasound signs of recurrence of urinary bladder endometriosis.