![]() Thus endodontic treatment refers to treating the inside of the tooth. The word Endodontics originates from the Greek words ‘endo’ meaning ‘inside’ and ‘odont’ meaning ‘tooth’. This approach requires a combined surgical treatment by a gynecologist and urologist or an experienced laparoscopist (table 4).Endodontic treatment is the technical name for the dental procedure commonly referred to as ‘root canal treatment’ or ‘root filling’. Combined transurethral partial cystectomy and laparoscopic reconstruction of bladder for the management of BE and coexisting abdominal endometriosis fits into the trend for minimally invasive surgery and it might be considered as an alternative treatment to traditional laparotomy in women with BE, especially in those who have simultaneous pelvic endometriosis. Finally, laparoscopic partial cystectomy offers the same results as open surgery with several advantages, including less bleeding, shortened operative time, shortened hospital stay, quicker return to work, a major reduction in postoperative pain and decreased risk of postoperative morbidity (table 4). Laparoscopy also permits simultaneous treatment of extravesical lesions and concomitant castration with or without hysterectomy (that is the preferable approach for patients without pregnancy desire or women approaching menopause). The outcome is excellent in different series, with pain relief reported in 95–100% of patients. A cystoscopy at the end of the procedure is advisable in order to ensure watertight closure and to check the ureteral orifices integrity. The bladder suture is generally performed by means of a single layer. Laparoscopic Partial Cystectomy: The laparoscopic approach includes the dissection of the vesicouterine space in order to mobilize the nodule and dissect the bladder with excision of the whole nodule together with some healthy tissue. ![]() The lesion is excised with mechanical scissors or unipolar electricity, and the bladder is finally oversewn with two transverse watertight fine synthetic absorbable sutures (table 4). Very often, one or both round ligaments are distorted and involved in the adhesive process. In these cases, segmental bladder resection might be performed by lysis of any adhesions between the anterior uterine wall and the vesicouterine fold of peritoneum. A more complex anatomical situation is encountered when the endometriotic lesion is located on the posterior wall of the bladder. The most favorable anatomical situation is when the endometriotic lesion affects the bladder dome. As it is usually not possible to remove the detrusor nodule without opening the bladder lumen, an intentional perinodular incision through the vesical dome is suggested by different groups. Laparotomic Partial Cystectomy: The procedure begins with careful recognition of the limits of the nodule and lysis of any adhesions between the anterior uterine wall and the vesicouterine fold peritoneum. The surgical urological treatment might lead to good results in terms of patients’ compliance and prognosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. Conclusions: The bladder is the most common affected site in urinary tract endometriosis. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The diagnosis has to be considered as a step-by-step procedure. Results: Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. Methods: We performed a literature review by searching the MEDLINE database for articles published between 19, limiting the searches to the words: urinary tract endometriosis, bladder endometriosis, symptoms, diagnosis and treatment. ![]() Study Objective: To define the state of the art in the diagnosis and treatment of bladder endometriosis. The surgical urological treatment might lead to good results. Background: The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up.
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