Endometriosis bladder

The time when the bladder endometriosis considered a rare disease in literature met only a few messages. Currently publications on this issue in the hundreds of observations [Abeshouse Century, Abeshouse G., 1960]. Nevertheless M Taus and J. of NOVATEK (1973) consider the manifestation of endometriosis in urology casuistry. This is due to insufficient familiarity with this pathology gynecologists and urologists, not uncommon diseases. Also, is the fact that many experts in the diagnosis of endometriosis, bladder are mainly focused on the cyclic hematuria. The latter is observed not in all patients.
The mechanism of injury to the urinary bladder endometriosis can be very diverse. First of all may hit the surface of the bubble content endometrioid ovarian cysts, retrograde casting menstrual blood containing viable elements of the endometrium, the growth of endometriosis of the isthmus and the anterior wall of the uterus into the bladder. Important in the parsed aspect is the abandonment of the isthmus of the uterus affected by endometriosis, after supracervical amputation of uterus, and sparing the volume of transactions on the uterus, delete the extension of the horns of the uterus or resection of the corner of uterine endometriosis, when to peritonization used the bladder. A role play operation vaginal cesarean section [Gottlieb So, 1957]. Probably haematogenous entry elements of the endometrium in the wall of the bladder. Our observations indicate significant role disintegrating factor in the pathogenesis of endometriosis in General and of the urinary bladder in particular. We watched 9 patients with congenital bladder endometriosis.
The clinical picture of endometriosis bladder largely depends on its origin, namely lesions, evolved as a result of implantation of the elements of the endometrium on the surface of the bladder, a long time remain asymptomatic. They are discovered by chance during chrevosechenie about the diseases of the organs of the pelvis and lower abdomen, with the persons who know this pathology. Distribution of endometriosis on the back wall of the bladder from the isthmus or stump cancer is accompanied by heavy dysuric phenomena. Congenital endometriosis, bladder, located in the area of the mouth of the urinary tract can also cause severe clinical picture.
The most frequent complaint in endometriosis, bladder is a feeling of heaviness in the lower abdomen and deep in the pelvis, worse before and during menstruation. In addition, at this time urination becomes more frequent, and in some patients - and painful. The severity of the pain varies from moderate to very strong and painful, depriving women of ability to work. Repeated examination of the urine and urological examinations, including cystoscopy, not discover the cause of suffering, they are diagnosed cystalgia. Symptomatic therapy is not efficient enough. Thermal procedures increase the pain. According to complaints from menstrual cycle somehow neglected.
Further to uchenomu and painful urination during menstruation is attached hematuria, the severity of which can be very diverse. At this stage of development of disease diagnosis recurrent hemorrhagic cystitis. Symptomatic therapy is still not effective.
The disease is chronic. From the appearance of fast and painful urination before hematuria, according to our data, it takes 3 to 5 years. Some patients with early hematuria pain when urinating several decrease. In the majority of patients for hematuria, uchenomu and painful urination joins fear of the presence of a tumor in the bladder. According to J. Jwano, G. Ewing (1968), hematuria in endometriosis, bladder occurs in 25 % of patients. F. Miculicz-Radecki (1936) observed hematuria in 5 out of 42 patients with this pathology. 18 our patients with endometriosis bladder hematuria was only 4. With extensive endometriosis, bladder, exciting his neck, there may be poor retention of urine. According to J. Goodal (1944), urinary incontinence is more often caused stromal form of endometriosis bladder.
Diagnosis is based on the cyclic nature of these complaints, there are signs of endometriosis, pelvic and data urological examination.
The results of cystoscopy depending on the phase of the menstrual cycle, the size of endometriosis and depth of growing into the wall of the bubble. Typical for endometriosis, bladder, exciting all its layers, is the presence of a slightly rising like formation with dark blue, hemorrhagic and purple-bluish small cysts 0.3 to 0.5 cm in diameter. The mucous membrane of the urinary bladder in this place swollen, with a strong injection of blood vessels. Sometimes there are noticeable only a few bluish small cysts or alopecia accumulation, much less frequent polypoid, easily bleeding tissue growth, reminiscent of a papilloma of the bladder. Some patients (hematuria) you can watch the bleeding of endometrioid inclusions during menstruation. At the end of menstruation and cystic polypoid education fade and become less noticeable, disappears swelling of the mucous membrane of the urinary bladder.

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