Deep infiltrating endometriosis (DIE) of the bladder is the most common location of external endometriosis, and has a high recurrence risk. A growing scientific evidence suggests that surgeries of the bladder DIE do not ensure long-term effects. There is a high recurrence rate of external endometriosis (nearly 37% of 5th- year recurrence rate with minimal lesions and 75% of 5th-year recurrence with severe endometriosis). Some sources are cited. I could cite myriads of confirming references, but this space is limited.

I believe your surgeon did his/her best and remained reserved to remove all the visible lesions of the bladder DIE based on his careful calculations of the risk/benefit ratio. The risk is high (bladder perforation) and the benefit is low (a high recurrence rate). The surgeon has taken all precautions to prevent the bladder perforation, and I support him/her.

Post-surgical care:

You will need a hormonal therapy (commonly, oral contraceptives) for the pain syndrome. This is how the hormonal treatment works:

- It temporarily turns off your ovaries so you don’t ovulate. (This also helps with external endometriotic lesions in the brain that manifest under a clinics of migrains. OCs help alleviate the headache in this case.) When you don’t ovulate, you don’t have regular periods. When you are prescribed hormonal treatment continuously, you will rarely have periods or not have them at all. Since periods can cause pain for anyone with endometriosis, stopping them will improve the pain.

Pregnancy is another brilliant and natural method of hormonal therapy. You are still young (40) and could consider having another baby (in the event your endometriosis did not cause infertility). I believe, during the laparoscopy the surgeon has checked whether your fallopian tubes needed cannulation. If the tubes are open, then think of pregnancy (just a suggestion).

Waller et al (1993). Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertility and Sterility; 59(3):511-5.

Chapron et al (2010). Surgery for Bladder Endometriosis: Long-term Results and Concomitant Management of Associated Posterior Deep Lesions. Human Reproduction; 25(4):884-889

We, as surgeons, must make a decision whether to leave untreated endometriosis or possibly injure the structure being operated on.

Has the pain improved at all? If it hasn't, it is possible that the pain is coming form another source like the bowel (IBS, colitis), Bladder (interstitial cystitis, UTI, Kidney stone), or abdominal wall structures. I would seek a second opinion from a specialist that can review the operative report as well as your medical history and develop a treatment plan suitable to treat your pain.

It's best to see another

physician who can

treat this.

Sometimes it is more advisable to leave endometriosis on structures where damage to underlying organs is high risk. These areas are typically treated with medicines such as depo-Lupron and

if necessary more delicate surgery can be performed.

Getting rid of the endometriosis on the bladder may or may not help the pain

You need further evaluation by someone knowledgeable about pelvic pain

It is sometimes necessary to leave some of the endometriosis than damaging the bladder. This should be followed by medical treatment to ease the symptoms. If additional treatments are necessary, it is beneficial to see an infertility specialist who may specialize in this problem and possibly eradicate the endometriosis with laser therapy.