Ceana H. Nezhat, MD, Maria Hincapie, MD, Anar Gojayev, MD, Adi Katz, MD
Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA (Drs. Nezhat and Hincapie)
Northwell Health Hospital-Gynecology, Queens County, New York, NY (Dr. Gojayev)
Lenox Hill Hospital- Gynecology, New Hyde Park, New York, NY (Dr. Katz)
Objective: Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. In an extensive literature review only 4 cases of suburethral endometriosis were identified. Our objective is to present a case of primary vaginal suburethral endometriosis in a 31-year old patient who underwent laparoscopic evaluation and to perform a literature review on this topic.
Methods and Procedures: Case report presentation based on information extracted from patient database. A review of literature with a Medline search using key words urethral endometriosis, suburethral endometriosis, or urethral diverticulum was undertaken.
Results: This case report describes a case of a 31-year old female patient referred for severe pelvic pain, worsening during menstruation. On physical examination a 2 cm suburethral endometriotic lesion was found as the initial presentation. Her examination was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. The review of literature revealed only 4 cases where suburethral endometriosis was previously identified.
Conclusion: Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision, and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions.
Key Words: Endometriosis, Laparoscopy, Suburethral, Surgical management.