LAUSR

We read with interest the recent publication by Vieira et al., Abdominal wall endometriosis (J Clin Urol 2017).1 A case is presented of a 36-year-old female with a past history of Caesarean delivery who presented with a painless abdominal wall mass that had been present for 6 months. The diagnostic work-up, operative management and histological confirmation of extra pelvic endometriosis are subsequently described. The authors proceed to discuss the surgical procedures that may precede the development of endometriosis and estimate the risk to be less than 1%.2 The authors then proceed to emphasize that the presentation is not always straightforward due to non-cyclical pain and the time lag between surgery and subsequent presentation. They conclude by stating that endometriosis should be included in the differential of an abdominal wall mass particularly if there is a history of Caesarean section and that treatment modalities include sclerotherapy.1 It should be acknowledged by the authors that in females with a past history of bladder exstrophy abdominal wall endometriosis has been reported twice.3,4 In 2014 we described a case in a 29-year-old female who underwent primary bladder closure in the first week of life and who subsequently presented with a painless abdominal swelling that was unrelated to her menses.3 Kitajima et al. in 2013 also reported a case in an exstrophy patient, but unlike our case the patient complained of pain.4 We agree with the authors that the presentation may be atypical and that a significant time lag may exist between surgery and onset of symptoms. Although normal vaginal delivery has been reported in exstrophy patients, Caesarean section is recommended.5 Therefore, ectopic endometriosis should also be considered as a differential diagnosis in the female exstrophy patient who presents to either the gynaecologist or urologist with an abdominal wall swelling following (a) Caesarean section or (b) if nulliparous, as exstrophy repair is also a risk factor for ectopic endometriosis.