Bladder & Ureter Endometriosis Surgery
When endometriosis grows into the bladder wall or wraps around a ureter, surgery removes it from the outside, where it starts, and frees the ureters to protect your kidneys.
- How
- Robotic excision from outside the bladder
- Protects
- Kidney and bladder function
- Catheter
- Often for several days after a bladder repair
Medically reviewed by Dr. Steven Vasilev, MD
Quadruple board-certified in surgical and integrative therapies, Minimally-Invasive Robotic Endometriosis-Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Oct 2026
- The bladder wallA nodule growing in from the outside, removed and the wall repaired.
- A narrowed ureterScar tissue and endometriosis squeezing it, freed in the same operation.
- The kidney above itDrains through that ureter. A blockage can make it swell, often without pain.
Endometriosis
Why a ureter can be blocked without pain
Scar tissue can narrow a ureter slowly, with little or no pain, while urine backs up into the kidney. That's why the ureters and kidneys are checked before surgery, even when you have no urinary symptoms.
Is it right for me?
When urinary symptoms flare with your period but tests show no infection, imaging shows a bladder nodule, or a ureter is narrowed.
Usually worth considering if
- Urinary symptoms that follow your cycleBurning, pressure, urgency or frequency that flares around your period.
- "UTIs" with negative culturesTreated again and again for infections the tests don't show.
- Imaging shows a bladder noduleOn an ultrasound with a partly full bladder, or MRI.
- A narrowed ureter or swollen kidneyOften found on imaging before it causes any pain.
- Blood in the urine with your periodUncommon, but a strong sign when it happens.
- Medication isn't enoughHormones can ease symptoms; they don't remove a nodule in the bladder wall.
Often improves
- Pain with urination, pressure and urgency caused by endometriosis
- A narrowed ureter, freed to protect the kidney
- Blood in the urine with your period
- Deep pelvic pain, when the rest of the disease is removed in the same operation
Won’t fix on its own
- Bladder pain syndrome (interstitial cystitis) or a sensitized bladder
- A lifetime cure: endometriosis is a chronic disease
Bladder symptoms can have more than one cause, so care continues after surgery with pelvic floor therapy and pain management when they're needed.
Most urinary symptoms in endometriosis don't mean the bladder needs surgery. But a ureter can narrow silently, so it's always checked.
How does it compare?
Removing it from outside the bladder reaches the whole nodule and the ureters. Treatment from inside the bladder, or medication alone, usually doesn't.
| Compared | Excision from outside the bladder | Removal from inside the bladder | Hormone medication |
|---|---|---|---|
| What it is | Robotic surgery: the nodule is shaved off, or a small piece of bladder wall is removed and repaired | A scope through the urethra trims what shows inside the bladder (TUR) | Pills, an IUD or injections that quiet the disease |
| What it removes | The whole nodule, which grows from the outside in | Only the inner part; the rest usually stays | Nothing; symptoms often return when it stops |
| The ureters | Checked and freed in the same operation | Not reached | Not protected if one is narrowing |
| Recovery | Often a catheter for several days after a repair, then a gradual return | Usually short | No surgery; side effects vary |
Excision from outside the bladder
- What it is
- Robotic surgery: the nodule is shaved off, or a small piece of bladder wall is removed and repaired
- What it removes
- The whole nodule, which grows from the outside in
- The ureters
- Checked and freed in the same operation
- Recovery
- Often a catheter for several days after a repair, then a gradual return
Removal from inside the bladder
- What it is
- A scope through the urethra trims what shows inside the bladder (TUR)
- What it removes
- Only the inner part; the rest usually stays
- The ureters
- Not reached
- Recovery
- Usually short
Hormone medication
- What it is
- Pills, an IUD or injections that quiet the disease
- What it removes
- Nothing; symptoms often return when it stops
- The ureters
- Not protected if one is narrowing
- Recovery
- No surgery; side effects vary
What happens, step by step?
A video consultation, imaging of the bladder, ureters and kidneys, a plan agreed in advance, then one operation.
Before surgery
Planning consultation
By video, with your symptoms, urine test results, imaging and any earlier operative reports.
Imaging the urinary tract
An ultrasound with a partly full bladder, or MRI, shows how deep a bladder nodule goes. The kidneys are checked for swelling, a sign that a ureter is narrowed.
More about Imaging the urinary tract
Cystoscopy, a look inside the bladder, helps in some cases, for example when there's blood in the urine. Because the disease grows from the outside in, a normal cystoscopy doesn't rule it out.
Your plan
Whether the bladder needs shaving or a small repair, whether a ureter needs freeing, and whether a urologist joins the operation, all agreed in advance. Insurance and a fixed price are settled before anything is booked.
Surgery day
The operation
Robotic, through small incisions. The ureters are found and protected first; then the bladder nodule is removed, and the bladder repaired if needed, along with the rest of the pelvic disease.
Often in the same operation: endometriosis excision · bowel surgery
More about The operation
Rarely, a narrowed piece of ureter has to be removed and the ureter reconnected to the bladder. That's planned with a urologist or gynecologic oncologist, not decided on the day.
In the hospital
Most often it is still a same-day outpatient procedure. When it isn't, how long you stay depends on everything that was treated. If the bladder was repaired, a catheter keeps it empty while it heals, often for several days; sometimes it comes out before you go home.
Recovery
- Weeks 1–2
Early recovery
Urgency, frequency or mild burning are common at first, and settle as the bladder heals.
- The weeks after
A gradual return
Back to work and exercise in stages, with clear guidance from your team on lifting and activity.
Follow-up
- 3 months
Follow-up
Your pathology results and a video check-in. If a ureter was freed or repaired, a scan checks that the kidney drains well.
Who should do it?
A surgeon who can remove disease from the bladder and free the ureters in the same operation, with a urologist when needed.
The bladder and ureters sit in the middle of deep pelvic disease, and scar tissue pulls them out of place. Many surgeons stop there, or treat only what shows inside the bladder. Dr. Vasilev trained as a gynecologic oncologist for exactly this space: removing disease from around the bladder and ureters while keeping them working.
“A ureter can be blocked without a single symptom. Checking for it is part of every plan in cases where advanced disease is suspected.”
Patients often ask
What does bladder endometriosis surgery involve and how is recovery?
Bladder endometriosis surgery may involve shaving a lesion off the bladder surface or removing a small segment of bladder wall and repairing it. Recovery typically includes a temporary urinary catheter for several days, and early urinary symptoms usually improve as healing progresses.
Will I need a catheter after bladder endometriosis surgery?
Often, yes, at least briefly, but it depends on what is needed to fully remove the bladder lesion. If surgery involves a full-thickness excision and bladder repair, a catheter is more commonly used to keep the bladder empty and protect healing.
Can endometriosis block a ureter without pain?
Yes, endometriosis can compress or narrow a ureter with little to no pelvic pain, especially when scarring gradually narrows it over time. This can silently back urine up toward the kidney, causing swelling and risking loss of kidney function.
Can medication cure bladder endometriosis lesions, or is surgery needed?
Medication can often ease bladder endometriosis symptoms, but generally does not remove deep bladder wall lesions. Surgery becomes more important if symptoms persist despite medication, imaging suggests deeper muscle invasion, or there is bleeding or urinary blockage.
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Next: Who should operate?What to look for in any surgeon, and Dr. Vasilev’s results.