EP13.39: Interobserver reliability and diagnostic accuracy of transvaginal ultrasound for adenomyosis: a multiobserver study

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Objectives: To describe patients sonographically diagnosed with Urinary System deep endometriosis (DIE) during years 2021-2022 in our medical center.Methods: Data was derived from medical file and telephone communication with the patients.Results: 8 patients were diagnosed with urinary system DIE. 2 patients had suspected DIE involving ureter.one of them had bilateral hypoechoic lesions adjacent to ovarian fossa with bilateral mild hydroureter.One had a suspected longitudinal hypoechogenic bladder DIE involving right ureter, with mild hydroureter.7 patients had suspected urinary bladder DIE.Average bladder DIE diameter was 22mm.The majority of foci, 71%, had heterogenous echogenicity.85% of bladder DIE where located in the bladder Dome.In 42% of patients the foci was bulging anteriorly, displacing the urinary bladder wall, and the different bladder layers where difficult to demonstrate in the DIE area.These findings suggested deep infiltration of bladder wall by DIE.In urinary system DIE patients, Suspected DIE in other sites was common (71%), mainly in the sacro uterine ligaments (57%).Adenomyosis was suspected in 75% (6/8), of which 4 patients had subserous adenomyosis adjacent to bladder DIE.62% (5/8) underwent surgery, one patient had partial cystectomy.Urinary system DIE was confirmed in all.62% received hormonal treatment.1 patient conceived spontaneously.At 1-1.5 years after examination, 75% had pain improvement, mostly partial or temporary improvement.1 patient was asymptomatic.Conclusions: In our small group of urinary system DIE patient, most urinary bladder DIE foci presented with heterogenic echogenicity and involved bladder dome.Diagnosis was confirmed in those surgically treated.Most patients remain symptomatic after treatment, with some degree of improvement of symptoms.