Diagnostic Approaches for Endometriosis-Related Urinary Tract Symptoms

Imaging and Diagnostic Tests

• Expanded protocol transvaginal ultrasound (TVUS) studies can help identify and map deep endometriosis, including bladder involvement 1
• CT urography is the preferred imaging modality for comprehensive evaluation of the urinary tract in patients with hematuria, with MR urography as an alternative if CT is contraindicated 2

Clinical Evaluation and Referral

• Gross hematuria has a high association with malignancy (30-40%), requiring a full urologic workup to rule out cancer 3, 4, 5
• If gross hematuria is present, urgent urologic referral is mandatory regardless of suspected cause, as malignancy must be excluded 2

Treatment Options

• Treatment options for bladder endometriosis include hormonal therapy such as progestins, GnRH agonists, or oral contraceptives, as recommended by the American Academy of Family Physicians 6, 7