SERDAR BALCI, Çağlan ERTUĞRUL, KUTSAL YÖRÜKOĞLU, EMİNE BURÇİN TUNA, MERAL KOYUNCUOĞLU ÜLGÜN, Recep Emre OKYAY, ÖMER ERBİL DOĞAN, GÜVEN ASLAN

Kronik pelvik ağrı ve siklik hematüri ile başvuran bir kadında mesanede endometriozis

Otuz altı yaşında, gebelik 2 doğum 1 abortus 1 ve 7 yıl önce sezeryan öyküsü bulunan hasta siklik hematüri (menüri) ve kronik pelvik ağrı yakınması ile başvurdu. Abdominopelvik ultrasonografide mesanede kitle şüphesiyle sistoskopi yapılarak biopsi alındı. Patolojik tanı mesanede endometriozis idi. Gonadotropin releasing hormon analoğu yakınması (leuprolide asetat) tedavisi 6 ay uygulandı. Tedaviden 2 ay sonra kasık ağrısı şikayeti ile tekrar başvurdu. Tanısal laparoskopi ve ikinci bakış sistoskopisi yapıldı ve endometriozis odaklarının regrese olduğu saptandı. Sıklıkla asemptomatik olsa da, ağrı ve pelvis dışında ele gelen bir kitlenin varlığı ekstrapelvik endometriozisin semptomları olabilir. Üriner endometriozis gibi sağaltımı zor bir hastalıkta tedavi basamaklarına kadın doğum ve üroloji uzmanları birlikte karar vermelidir. Yakınmaların şiddeti, hastalığın yaygınlığı, tekrarlama olasılığı ve tedavi maliyeti göz önüne alınarak doğru tedavi yöntemi hastaya önerilmelidir.

Anahtar Kelimeler:

pelvik ağrı, hematüri, endometriozis

Bladder Endometriosis In A Woman Who Complains About Chronic Pelvic Pain And Periodic Hematuria

A 36 year old woman with 2 pregnancies which one of them is delivered by cesarean section 7 year ago and the other one was abortus applied for periodic hematuria (menuria) and chronic pelvic pain. Cystoscopy was performed and bladder mucosal biopsy was obtained because of suspicious bladder mass in abdominopelvic ultrasonography. Pathological diagnosis was bladder endometriosis. Gonadotrophin releasing hormon analog ( leuprolide asetat) treatment was used for 6 months. 2 months after therapy she applied again with pelvic pain. Diagnostic laparoscopy and second look cystoscopy was performed and regression of the endometriotic foci were seen. Pain and palpable mass out of pelvis may be a symptom of extrapelvic endometriosis although it is frequently asymptomatic. Urinary endometriosis is an unrecoverable disease, and collective approach of the gynecologist and urologist is necessary for treatment options. The severity of symptoms, spread of disease, probability of recurrences and cost of treatment shoud be considered and accurate modality of the treatment shoud be offered to the patient.

Keywords:

pelvic pain, hematuria, endometirosis,

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