NEW YORK (Reuters Health) - Conservative surgery provides long-term relief for many women with bladder endometriosis, say researchers from Italy.

Dr. Luigi Fedele from University of Milan, and colleagues investigated long-term outcomes after partial cystectomy by laparoscopy or laparotomy in 47 women with symptomatic bladder endometriosis.

After a median follow-up of 33.5 months, 8 women (17.5%) reported recurrence of at least one symptom of bladder endometriosis, the authors report. Clinically and instrumentally proven recurrence was confirmed in only 5 women (10.9%).

All recurrences occurred among women who had vesical base involvement, the report indicates, whereas no recurrences were noted in women with lesions of the vesical dome.

The extent of the surgical procedure also influenced recurrence, the researchers note. Recurrence was less frequent when resection included both the myometrium adjacent to the vesical lesion and the vesical wall than when less extensive resection was performed.

Eleven women went on to become pregnant, the results indicate. Nine delivered at term, but 2 had spontaneous miscarriages.

"Conservative surgical treatment of bladder endometriosis seems effective in ensuring long-term relief in almost all cases of endometriosis affecting the vesical dome," the authors conclude, "whereas success rates for deeper lesions involving the vesical base and the vesicouterine septum are lower, depending on the degree of surgical radicality."

"We are planning a clinical study to better define the indications and feasibility of laparoscopy approach for bladder endometriosis," Dr. Fedele told Reuters Health. "We are studying the efficacy and safety of hormonal treatment, since no data are available on medical treatment of bladder endometriosis; in particular, we are studying some hormonal devices."

Fertil Steril 2005;83:1729-1733

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