Bladder, ureter & renal pelvis

Other nonneoplastic


Topic Completed: 1 July 2011

Minor changes: 7 February 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Endometriosis

Alcides Chaux, M.D.
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Cite this page: Chaux A. Endometriosis. website. Accessed October 21st, 2021.
Definition / general
  • Presence of functional endometrial tissue within bladder

  • Rare in ureter but can result in renal failure due to silent obstruction
  • Associated with hydroureter / hydronephrosis
  • Tendency to involve distal third of left ureter (Hum Pathol 2008;39:954)
  • Extrinsic: involving serosal or peritoneal surface (adventitia or connective tissue)
  • Intrinsic: involving muscularis propria, lamina propria, lumen
  • Rarely malignant transformation or endometrial hyperplasia can be present
  • Women between the second and fifth decades
  • Uncommon, occurs in < 2% of all patients with endometriosis
  • Seen in post menopausal women receiving exogenous estrogen
  • Also can occur, very rarely, in men taking estrogens for prostate cancer
  • Usually posterior wall of bladder above trigone or at dome
  • Probably due to retrograde menstruation, which seeds surface of bladder serosa or postsurgical
  • Not due to metaplasia of Müllerian remnants or extension from anterior uterine adenomyosis (Am J Obstet Gynecol 2002;187:538)
Clinical features
  • Bladder is the most common site (70 - 80%) of endometriosis of the urinary tract
  • May develop into endocervicosis (mucinous metaplasia), endometrioid adenocarcinoma, clear cell carcinoma, adenosarcoma
  • Usually associated with prior surgery or female GU symptoms of urgency, frequency, suprapubic pain, rarely hematuria
  • Mass is frequently apparent either by palpation or cystoscopic examination
  • Bladder implants typically occur at vesicouterine pouch; may grow through muscularis into submucosa, producing a luminal bulge or rarely a polypoid mucosal mass (Radiographics 2006;26:1847)
  • Mucosa may appear blue at cystoscopy
Case reports
Clinical images

Images hosted on other servers:

Laparoscopic segmental cystectomy

Gross description
Microscopic (histologic) description
  • Resembles endometriosis elsewhere: endometrium-like glandular epithelium associated with endometrial stroma cells and recent or old hemorrhage
  • Rarely, only glands or stroma are found

  • Similar to endometriosis seen elsewhere, diagnosis based on the presence of endometrial glands (usually inactive or proliferative pattern) with endometrial stroma (usually normal appearing), sometimes restricted to a thin zone around the glandular component
  • Foamy or hemosiderin laden macrophages
  • Sometimes a fibrotic reaction
Microscopic (histologic) images

Images hosted on other servers:

Endometrial glands and
stroma involving the
peri-ureteral soft tissue

Positive stains
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