Anterior Focal Adenomyosis and Bladder Deep Infiltrating Endometriosis, Is There a Link?
Abstract
Study objective To evaluate the association between bladder deep infiltrating endometriosis (DIE) and anterior focal adenomyosis of the outer myometrium (aFAOM) diagnosed by preoperative magnetic resonance imaging (MRI).Design An observational, cross-sectional study using prospectively collected data (Canadian Task Force classification II-2).Setting Single university tertiary referral center.Patients All nonpregnant women younger than 42 years who had undergone complete surgical exeresis of endometriotic lesions. For each patient a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon during the month preceding the surgery. Only women with preoperative standardized uterine MRI were retained for this study.Interventions Thirty-nine women with histologically proven bladder DIE and an available preoperative MRI were enrolled in the study. Patients were divided into 2 groups: women with aFAOM (aFAOM (+), n = 19) and women without aFAOM (aFAOM (-), n = 20). Both groups were compared for general characteristics, medical history, MRI findings, and disease severity.Measurements and main results Nineteen patients (48.7%) with bladder DIE had aFAOM at preoperative MRI. The rate of associated diffuse adenomyosis was similar in the 2 groups (63.2% [n = 12] vs 73.7% [n = 14]; p = .48). The rate of an associated ovarian endometrioma (OMA) was significantly lower in the aFAOM (+) group (10.5% [n = 2] vs 40.0% [n = 8]; p = .03). There were fewer associated intestinal DIE lesions in the aFAOM (+) group compared with the aFAOM (-) group (26.3% vs 75.0%; p = .02), with lower involvement of the pouch of Douglas (26.3% vs 70%; p < .01). Total American Society for Reproductive Medicine score was significantly lower in the aFAOM (+) group (13.8 ± 12.2 vs 62.2 ± 46.2; p < .01).Conclusion aFAOM is present in only half of women with bladder DIE and appears to be associated with lower associated posterior DIE.
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The newly reported association between focal adenomyosis of the outer myometrium and deep endometriosis suggests not all subtypes of adenomyosis are the same and may have different pathogenesis.
“Indeed, the newly reported association between focal adenomyosis of the outer myometrium (FAOM) and deep endometriosis (DE) [61,62] suggests that not all subtypes of adenomyosis are the same and may have a different pathogenesis.”
From The Pathogenesis of Adenomyosis vis-à-vis Endometriosis (2020) · cites this paper as [62]
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- Authors
- Marcellin, L., Santulli, P., Bortolato, S., Morin, C., Millischer, A. E., Borghese, B., & Chapron, C.
- Affiliations
- Inserm (FR)
- Sorbonne Paris Cité (FR)
- Corresponding author
- Chapron, Charles
- ORCID
- Venue
- Journal of Minimally Invasive Gynecology
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 25
- Issue
- 5
- Pages
- 896-901
- ISSN
- 1553-4650 (ISSN-L)
- OpenAlex
- W2790713581
- Cited by
- 51
- References
- 29
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 6 · 2020: 12 · 2019: 4 · 2018: 1
- FWCI
- 6.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Minimally Invasive Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- deep infiltrating endometriosis, bladder endometriosis, diffuse adenomyosis, endometrioma, intestinal endometriosis, pouch of Douglas, uterine MRI
- MeSH terms
- Adult, Urinary Bladder Diseases, Cross-Sectional Studies, Endometriosis, Female, Humans, Magnetic Resonance Imaging, Peritoneal Diseases, Adenomyosis
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