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18 MOGS Chronicles | Volume 1 | Issue 1 | September 2024IntroductionThe identification of endometriosis has been a subject of intense debate over the last decade. Endometriosis is a painful condition that affects up to 10% of women of reproductive age and is characterized by the presence of endometrial glands and stroma, similar to those that line the uterus, growing elsewhere in the body.[1] One type of endometriosis is urinary tract endometriosis (UTE). It affects 0.3%u201312% of all endometriosis patients.[2] The urinary system is the second most common site of extrapelvic endometriosis after the gastrointestinal tract (3). The prevalence of disease at specific sites among women with UTE is as follows: bladder, 85%; ureter, 10%; kidney, 4% and urethra, 2%.[4]Although bladder is the most common site of UTE, bladder endometriosis (BE), in general, is rare. In most cases, BE is associated with lower urinary tract symptoms such as frequency and dysuria. Dysuria has been reported in 21%u201369% of patients with BE and positive correlation was observed between severity and lesion diameter. Presence of cyclical haematuria is considered pathognomic of BE.Case ReportA 29-year-old female, P1L1A1, previous 1 lower segment caesarean section, done 6 years ago came with chief complaints of cyclical dysuria and dysmenorrhea which was premenstrual and menstrual since 3 years. No history of haematuria/burning micturition/increased frequency/urgency/urinary incontinence/heavy menstrual bleeding.Cycles were regular with moderate flow. She had been consulting many doctors since then but with unsatisfactory outcomes to various treatments. She had no significant past history. She was taking Tab. Dienogest 2mg since 2019 with no relief in her symptoms.General examination was within normal limits. Abdominal examination was within normal limits and a well healed Pfannenstiel incision was noted. Pelvic examination was suggestive of a normal sized anteverted uterus with restricted mobility, bilateral fornices were free and non-tender.Routine preoperative blood investigations were done. All were within normal limits. Urine routine and microscopy revealed 7%u20138 red blood cells per high power field and 1%u20132 pus cells per high power field. CA-125 was 21U.Lesions were first diagnosed on 3D ultrasonography which appeared irregular and polypoidal of size 14%u00d713%u00d710 mm along posterior wall of bladder and obvious internal vascularity was noted on colour doppler [Figure 1] computed tomography scan revealed hypoechoic thickening at the scar which was adherent to the bladder with echogenic lesion in bladder of 1.4%u00d71.3%u00d71 cm at uterine scar.A multidisciplinary team of expert laparoscopic surgeons and urologists were involved. Cystoscopy with laparoscopy was planned. On cystoscopy- evidence of 4%u00d75 mm large papillary broad base nodule near the left ureteric orifice with presence of a blue coloured clot was noted. The lesion was then demarcated using a 26Fr monopolar resectoscope and Collin%u2019s knife electrode with 1mm margin. Bilateral ureteric catheterisation was done. Demarcation around the lesion was deepened till full thickness of bladder muscle and lesion margins were confirmed laparoscopically [Figure 2]. Bladder was densely adherent to the lower uterine segment; hence adhesions were carefully separated by blunt and sharp dissection and bladder was mobilised. Endometriotic nodule was excised in full thickness laparoscopically and send for histopathological diagnosis. Bladder was sutured Urinary tract endometriosis (UTE) is an uncommon but serious manifestation of deep infiltrating endometriosis, carrying the risk of urinary tract obstruction and potential renal dysfunction. We present a case involving a 29-year-old female with cyclic dysuria and dysmenorrhea. This report highlights the diagnosis and surgical management of UTE. Awareness of UTE is crucial for specialists due to its significant health implications. In cases where UTE is identified, a multidisciplinary approach involving both radiological and surgical expertise is essential for optimal patient outcomes.Keywords:Genitourinary endometriosis, bladder nodule, deep infiltrating endometriosisGenitourinary Endometriosis - A Case ReportJil Kadakia, Shivani Agrawal, Sadhana Desai, Prashant BhamareDepartment of Obstetrics and Gynaecology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, IndiaAddress for correspondence: Jil Kadakia, Department of Obstetrics and Gynaecology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India. E-mail: jilkadakia506@gmail.comCase ReportAbstract