Treatment of Endometriosis When Symptoms Are Concerning for Deep Infiltrating Disease Involving the Bowel, Bladder, or Ureter
Patients with endometriosis who present with symptoms raising concern for deep infiltrating disease — particularly involvement of the bowel, bladder, or ureter — require a targeted evaluation pathway that differs from management of superficial endometriosis.
Symptoms concerning for deep infiltrating endometriosis involving the bowel, bladder, or ureter indicate the need for advanced imaging before definitive management decisions are made.
Advanced pelvic imaging — typically without contrast media — is the preferred first step in this scenario, followed by specialist consultation for further evaluation and management.
The complete structured protocol, including full imaging guidance and the management pathway, is available below.
References
Patient has additional symptoms concerning for deep infiltrating endometriosis.
If there is concern for deep infiltrating endometriosis involving the bowel, bladder, or ureter, then magnetic resonance imaging of the pelvis (and abdomen, if indicated), typically without contrast media depending on the clinical scenario, is preferred, although it does have a higher cost than TVUS.
Manage in consultation with obstetrician-gynecologist for further evaluation and treatment.
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