Anatomopathological lesions of bladder endometriosis are heterogeneous

Objective: To present the anatomopathological characteristics of deep bladder endometriosis. Design: Descriptive anatomapathological study. Setting: A university hospital department of gynecological surgery. Patient(s): Eleven consecutive patients complaining of pelvic pain and painful urinary functional symptoms. Intervention(s): Laparoscopic partial cystectomy. Main Outcome Measure(s): Macroscopic and microscopic characteristics of deep bladder endometriosis lesions. Result(s): Deep bladder endometriosis lesions were extremely heterogeneous, not only in any one patient but also from one patient to another. Bladder muscularis propria presented three aspects: [I] hyperplasia of the fibromuscular tissue (4/11); [2] simple dissociation of the smooth muscle fiber bundles with no veritable "disorganization" (4/11); [3] simple thickening of the interstitial collagen network, or sclerosis (3/11). A histological adenomyotic nodule aspect was only observed in one patient (9%). Conclusion(s): Bladder endometriosis is an enigmatic disease. No hypothesis can be proposed as a single explanation for its pathogenesis.