Bladder Endometriosis
A 38-year-old woman presented to the outpatient urology clinic with a 6-month history of intermittent gross hematuria, pain with urination, and pelvic pain. Her medical history was notable for a cesarean section 6 years earlier and a total abdominal hysterectomy for uterine myoma and adenomyosis 1 year earlier. On physical examination, there was no abdominal or pelvic tenderness. Ultrasonography followed by abdominal and pelvic computed tomography revealed a hypervascular mass (5.3 cm by 4.3 cm by 4.2 cm) over the bladder dome (Panel A, arrow). Cystoscopy showed edematous submucosal multiloculated lesions at the bladder dome (Panel B). The results of a biopsy of the lesion were nondiagnostic. Partial cystectomy was performed, and histopathological analysis confirmed the diagnosis of bladder endometriosis. Bladder endometriosis may be asymptomatic or associated with urinary urgency or frequency, dysuria, or cyclical gross hematuria. The woman had no recurrence at follow-up 1 year later.