Symptoms of endometriosis of the urinary system.
It should be emphasized that the classic (characteristic) symptoms of endometriosis with endometriosis of the urinary system are rare. Prevalence of complaints common to common forms of genital endometriosis. The pain in the lower half of the abdomen and lumbar region, caused by stagnation of urine, secondary infection of the urinary tract, comes to the fore.
With endometriosis of the bladder, the following symptoms of endometriosis are most often observed.
pain in the suprapubic region.
intermittent pain when urinating.
frequent urge to urinate.
burning in the urethra.
hematuria (less often.
Symptoms of endometriosis of the intestine.
The clinical symptoms of endometriosis of the intestine are due to the severity of the lesion of the colon wall. Endometriosis affects the large intestine from the side of the serous membrane. When the pathological infiltrate spreads to the serous and muscular layers, patients complain of symptoms of pain in the lower abdomen before and during menstruation, dyshexia, tenesmus, flatulence, and sometimes diarrhea.
When infiltrating the endometrioid infiltrate deeper, up to the mucous membrane and the mucous membrane of the colon, there is an increase in pain in the lower abdomen, dyshexia, flatulence, vomiting, constipation, admixture of blood in the stool, clinical picture of partial or complete colonic obstruction.
Leading can be gynecological symptoms of endometriosis (chronic pelvic pain, menorrhagia, dysmenorrhea, dyspareunia), which often mask the defeat of the colon. In this regard, the diagnosis of endometriosis of the colon, determining the extent of its spread become particularly important for the selection of adequate surgical treatment and rehabilitation.
Diagnosis of intestinal endometriosis.
Methods of diagnosis of intestinal endometriosis.
An important role in the diagnosis of endometriotic lesions of the urinary system is played by an x-ray study. Urograms and retrograde pyelograms in endometriosis of the intestine can detect narrowing of the ureters, more often in the lower third. The most common stricture is formed at a distance of 2-5 cm from the ureteral orifice. External endometriosis (exogenous) on pyelograms looks like a limited constriction. This form of endometriosis of the ureter must be differentiated with pelvic tumors, retroperitoneal fibrosis, iliac artery aneurysms, and tubo-ovarian abscesses.
Endogenous endometriosis should in turn be distinguished from primary tumors of the ureters, strictures of another genesis and X-ray negative stones of the ureters.
Diagnosis of endometriosis of the intestine – cystoscopy of the bladder.
The most reliable method of diagnosing endometriosis of the intestine and bladder is cystoscopy. Typically, the focus of the endometriosis of the intestine looks like a convex dense site on the back of the bladder or near the triangle Lieto. The mucous membrane of the bladder in the affected area is edematic, hyperemic, the endometriosis focus is represented by the formation of a cystic, cyanotic-purple color, the magnitude and color depend on the phase of the menstrual cycle. The value of cystoscopy increases as a result of the possibility of a biopsy of the mucosa of the bladder.
These changes are differentiated with varicose veins of the bladder mucosa, angiomas, inflammatory changes, papillomas, bladder carcinoma.
Endoscopic methods, in particular ureteropyeloscopy, open new possibilities in the detection of endometriosis of the intestine, renal pelvis and ureter.
A more detailed study of the organs of the urinary system is advisable to carry out when the endometrioid infiltrate is spreading to the fiber of the parameters and the small pelvis, which is most often the case with the endocutaneous localization of endometriosis.
Endometriosis of the intestine – diagnosis of the large intestine.
With the widespread forms of symptoms of genital endometriosis, especially when the pathological process is localized in retrocervical fiber, it is necessary to perform diagnostic methods that assess the condition of the large intestine. One of the methods of research with symptoms of endometriosis and lesions of the distal parts of the colon is irrigoscopy (examination of the large intestine with a barium enema.
There are the following radiographic signs of endometriosis of the distal parts of the colon: with the prevalence of the process on the surface of the shell of the colon – frequent, uneven gaustration, increased peristalsis; with the invasion of the endometrioid process to the entire depth of the intestinal wall – uneven contours, narrowing of the colon’s lumen, symptoms of bowel fixation, filling defect with smooth gaustres.
For the detection of endometriosis of the distal parts of the colon, endoscopic studies (sigmoidoscopy and colonoscopy are more informative.
When evaluating the endoscopic picture, special attention should be paid to tumor-like formations or infiltrates that protrude into the lumen of the intestine from the outside, as well as narrowing the lumen of the large intestine. The condition of the mucosa over the endometrioid infiltrate is characterized by the following features.
hypertrophic changes – edema, hyperemia, vascular injection.
atrophic changes – thinning folds, pallor, smoothness of the vascular pattern.
contact bleeding, soreness.
polypoid growths in the focus zone.
displacement of the mucosa over the lesion.
A biopsy of endometriotic lesion during endoscopic examination allows verifying the diagnosis.
In 1993, we proposed a method of chromospectromanoscopy and chromocolonoscopy by staining the mucous membrane of the colon with an enema of 1-1.5 liters. 0.25% aqueous solution of methylene blue. These methods allow before the operation to determine the degree of endometriosis damage to the wall of the colon, which is important for rational preoperative preparation and determination of the scope of surgical intervention. Staining of the mucous membrane over the endometrioid infiltrate and those not involved in the pathological process of the colon sections in blue indicates the intactness of the mucosa over the lesion. The absence of staining of the intestinal mucosa above the infiltrate indicates invasion of the entire thickness of the intestinal wall. This is due to the fact that as the endometriosis expands into the thickness of the intestinal wall, fibrotic changes begin to predominate, the intestinal wall becomes unevenly entangled in the infiltrate, as if corrugating on it.
To identify endometrioid infiltrates in endometriosis of the intestine and formations, to determine the state of the distal parts of the colon, we developed a method of transvaginal echography with additional contrasting of the rectum. The essence of the method is to contrast the rectum. Preparation of patients is carried out in the same way as for colonoscopy. Immediately before the test, a polyethylene rectal probe with a rounded end and a latex rubber balloon fixed on it is injected into the rectum above the level of the uterine isthmus. Then, using a Janet syringe, the balloon, located in the lumen of the gut, is filled through the probe with 300-400 ml of a solution of furacilin.
Methods of diagnosis of endometriosis of the intestine – ultrasound.
The method of ultrasound with additional contrasting of the rectum more than 2 times compared with traditional echography increased the accuracy of the diagnosis of retrocervical endometriosis (89.5%) and lesions of the distal colon (81.6%) with endometriosis symptoms.
Thus, when the neighboring organs are affected by the symptoms of endometriosis, it is necessary to determine the extent of the lesion, the disruption of the function, the topographic characteristics before the operation (X-ray and endoscopic methods, and transvaginal echography with simultaneous vaginal rectal examination.
Computed tomography to identify common forms of endometriosis of the intestine with affection of neighboring organs and tissues also play an important role in determining the radical nature of the operation.