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Wu S, Min Z, Wu L, Zhang M, Wu L. A urethral leiomyoma presenting with dysuria: A rare case report. Medicine (Baltimore) 2024; 103:e37893. [PMID: 38758882 PMCID: PMC11098236 DOI: 10.1097/md.0000000000037893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/22/2024] [Indexed: 05/19/2024] Open
Abstract
RATIONALE Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. We hereby report a case of a 44-year-old female who presented with complaints of dysuria. PATIENT CONCERNS A 44-year-old female patient presented to the urology outpatient clinic with symptoms of dysuria. The patient described the presence of a protrusion from the urethra during urination. DIAGNOSIS Urethral leiomyoma. INTERVENTIONS Physical examination confirmed a solid urethral mass. CT scan and USG reports indicated that the mass originated from the mid-urethra with vascularity at the base. We performed a complete resection of the urethral mass. The patient was discharged after 3 days of observation. OUTCOME During a follow-up after 1 month, the patient reported improved urinary flow and no occurrence of hematuria. The patient recovered well after discharge. LESSON Urethral leiomyoma is a rare benign tumor that is often misdiagnosed in clinical practice. Diagnosis requires careful clinical examination. Surgical removal usually works well. It is important to remember that in some cases of acute urinary retention, it can be caused by a complete obstruction of a mass in the urethra. Urologists should be more cautious and experienced in handling such cases.
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Affiliation(s)
- Shuo Wu
- Department of Urology, The First Peoples’ Hospital of Hangzhou Linan District, Hangzhou, China
| | - Zhichao Min
- Department of Urology, The First Peoples’ Hospital of Hangzhou Linan District, Hangzhou, China
| | - Lingyan Wu
- Department of Ultrasound, The First Peoples’ Hospital of Hangzhou Linan District, Hangzhou, China
| | - Mengsi Zhang
- Department of Pathology, The First Peoples’ Hospital of Hangzhou Linan District, Hangzhou, China
| | - Lejun Wu
- Department of Urology, The First Peoples’ Hospital of Hangzhou Linan District, Hangzhou, China
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2
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Abdulwahab Almansour H, Bokhari A, AlTamimi AD, Alshammari HA, Abd El Moneim Abdo YH. Partial Cystectomy Management of Bladder Leiomyoma in a Patient With Recurrent Urinary Tract Infections: A Case Study. Cureus 2024; 16:e56419. [PMID: 38638751 PMCID: PMC11026031 DOI: 10.7759/cureus.56419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Bladder leiomyomas are uncommon benign soft tissue neoplasms of the bladder, frequently observed in women. Diagnosis often happens incidentally during ultrasonography, with symptoms varying based on tumour size and location. Here, we present a case of a 57-year-old woman with poorly controlled type 2 diabetes mellitus, successfully treated for bladder leiomyoma through transurethral resection and laparoscopic partial cystectomy. This case highlights the significance of early detection and timely intervention in optimizing patient outcomes for bladder leiomyoma.
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Affiliation(s)
| | - Akram Bokhari
- Surgery, University of Hail College of Medicine, Hail, SAU
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3
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Wen Z, Liu Y, Hao P, Yang X. Leiomyoma of the urethra: a rare benign tumor. J Int Med Res 2022; 50:3000605221126662. [PMID: 36168731 PMCID: PMC9523852 DOI: 10.1177/03000605221126662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein report a rare case of leiomyoma of the urethra. A young woman with no history of malignancy was referred to our hospital because of a 1-year history of frequent urination, urgency, and dysuria. Postoperative pathologic examination confirmed the diagnosis of urethral leiomyoma. After tumor resection, the patient was followed up for 2 months in the outpatient department and developed no obvious postoperative complications such as urinary incontinence.
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Affiliation(s)
- Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Peng Hao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - XueSong Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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4
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Wang X, Lei J, Zhang W, Zhou J, Song L, Ying T. The ultrasonographic characteristics of female periurethral solid masses. Int Urogynecol J 2022; 33:605-612. [PMID: 35006310 DOI: 10.1007/s00192-021-05022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Studies on the imaging of female periurethral masses are sparse, and most are focused on cystic lesions. In this article, we studied female periurethral solid masses and reported their ultrasonographic features. METHODS Fifteen women with periurethral solid masses pathologically diagnosed between January 2008 and April 2021 were assessed. RESULTS Each patient had only one mass. The pathological types included urethral caruncle (5 patients), urethral leiomyoma (3 patients), urethral malignant tumor (MT) (3 patients), periurethral spindle tumor (3 patients) and cartilage necrosis of pubic symphysis (PS) (1 patient). On ultrasound, all urethral caruncles were located at the urethral meatus. They were hypoechoic/isoechoic and rich in blood flow signal. Each leiomyoma presented as a well-defined hypoechoic mass with an oval shape. The urethral MT had inhomogeneous/isoechoic echoes, with medium to abundant blood flow signal. The spindle cell tumors had regular/irregular shapes, moderate/high density echogenicity and little/rich blood flow signals. The articular cartilage necrosis of PS was regular in shape, with mixed echogenicity and no blood flow. CONCLUSIONS Ultrasound imaging is a convenient and useful method to evaluate the morphological characteristics of female periurethral solid masses.
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Affiliation(s)
- Xia Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Jiewen Lei
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Wei Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Junhong Zhou
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Popov SV, Orlov IN, Chernysheva DY, Grin’ EA. Urethral leiomyoma: A rare neoplasm. Urol Ann 2021; 13:194-197. [PMID: 34194152 PMCID: PMC8210724 DOI: 10.4103/ua.ua_90_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/05/2021] [Indexed: 11/04/2022] Open
Abstract
Extrauterine leiomyoma is a rare benign tumor, originating from smooth muscle cells, most often localized in the uterus. Extrauterine localization of leiomyoma is extremely rare. The presence of a neoplasm near the urethra always poses a challenge for differential diagnosis. Variety of pathologies sharing similar clinical findings requires further diagnostic testing and doctor alertness. We present the clinical case of urethral leiomyoma in a female patient aged 42 years complaining of frequent urination and vulval mass. The patient underwent neoplasm removal with further histologic examination revealing urethral leiomyoma. The article features the diagnosis and treatment of this rare pathology.
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Affiliation(s)
- Sergey V. Popov
- Department of Urology, St. Luke's Clinical Hospital, Saint-Petersburg, Russia
- Department of Urology, Military Medical Academy Named After S.M. Kirova, Saint-Petersburg, Russia
- Department of Hospital Surgery, Saint-Petersburg State University, Medical Faculty, Saint-Petersburg, Russia
| | - Igor N. Orlov
- Department of Urology, St. Luke's Clinical Hospital, Saint-Petersburg, Russia
- Department of Urology, North-Western State Medical University Named After I.I. Mechnikov, Saint-Petersburg, Russia
| | | | - Evgeniy A. Grin’
- Department of Urology, St. Luke's Clinical Hospital, Saint-Petersburg, Russia
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6
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Laparoscopic management of a large urethral leiomyoma. Int Urogynecol J 2019; 30:1211-1213. [PMID: 30756139 DOI: 10.1007/s00192-019-03889-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS A 42-year-old female presented with a 12-cm mass bulging the anterior vaginal wall and causing urgency urinary incontinence and bulk symptoms. METHODS Imaging showed a tumor originating from the dorsal and cranial part of the urethra and developing in the vesicouterine space and vesicovaginal septum, dislocating the bladder ventrally and the uterus cranial-dorsally. RESULTS Tranvaginal biopsy showed a benign leiomyoma. A laparoscopic approach with development of the vesicouterine space permitted a safe partial morcellation of the myoma. After the bladder and vaginal wall had been completely freed, further caudal dissection was conducted with isolation of the distal cranio-dorsal portion of the urethra. The dissection plane with the vaginal wall was developed up to the caudal margin of the urethral myoma almost corresponding to the vulvar plane, and total excision of the lesion was performed. CONCLUSION Laparoscopic management of urethral leiomyomas that develop into the vesicouterine space and vesicovaginal septum is feasible and safe also for very large lesions.
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7
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Vaginal Myomectomy to Resolve Bladder Outlet Obstruction 50 Years After Hysterectomy. Female Pelvic Med Reconstr Surg 2018; 24:e26-e28. [PMID: 29688898 DOI: 10.1097/spv.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence. CASE Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence. CONCLUSION Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.
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8
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Borisenkov M, Pandey A, Piesche S, Keller H. [Rare tumor as a cause for urinary retention]. Urologe A 2017; 56:1168-1170. [PMID: 28707097 DOI: 10.1007/s00120-017-0454-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M Borisenkov
- Klinik für Urologie, Kinderurologie, Urologische Onkologie und Palliativmedizin, Sana Klinikum Hof, Eppenreuther Str. 9, 95032, Hof, Deutschland.
| | - A Pandey
- Klinik für Urologie, Kinderurologie, Urologische Onkologie und Palliativmedizin, Sana Klinikum Hof, Eppenreuther Str. 9, 95032, Hof, Deutschland
| | - S Piesche
- Klinik für Urologie, Kinderurologie, Urologische Onkologie und Palliativmedizin, Sana Klinikum Hof, Eppenreuther Str. 9, 95032, Hof, Deutschland
| | - H Keller
- Klinik für Urologie, Kinderurologie, Urologische Onkologie und Palliativmedizin, Sana Klinikum Hof, Eppenreuther Str. 9, 95032, Hof, Deutschland
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9
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Urethral Leiomyoma: A Rare Clinical Entity. Case Rep Surg 2016; 2016:6037104. [PMID: 27999705 PMCID: PMC5141528 DOI: 10.1155/2016/6037104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/09/2016] [Indexed: 11/18/2022] Open
Abstract
Extrauterine leiomyomas are encountered occasionally, which can pose a diagnostic dilemma and challenge to the gynaecologist. We report a rare case of urethral leiomyoma. A 31-year-old woman with history of primary subfertility presented with mass at her urethral meatus and lower urinary tract symptoms. She underwent examination under anaesthesia and excision of the urethral mass. Histopathological examination confirmed leiomyoma. Diagnosis and management of this common growth situated at a rare location were reviewed and discussed.
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10
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Heller DS. Lesions of the Female Urethra: A Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Debra S. Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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11
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Benazzouz MH, Laadam K, Essatara Y, Sayegh HE, Iken A, Benslimane L, Jahid A, Nouini Y. [Not Available]. Can Urol Assoc J 2015; 8:e910-2. [PMID: 25553165 DOI: 10.5489/cuaj.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Le léiomyome de l’urètre est une tumeur bénigne rare constituée detissus musculaires lisses. Cette tumeur se traduit par une variété designes cliniques ; le recours à l’histologie est donc nécessaire pourposer le diagnostic. Le traitement de choix est l’exérèse chirurgicale.Aucun cas de dégénérescence maligne n’a été signalé jusqu’àprésent, mais une récidive locale est possible en cas d’exérèseincomplète. Les auteurs font état d’un nouveau cas de léiomyomeintéressant à la fois le col vésical et l’urètre, et se traduisant par ladysurie chez une patiente ; ils proposent également une revue dela littérature concernant cette pathologie.
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Affiliation(s)
| | - Karima Laadam
- Service d'Anatomo-pathologie, Hôpital Ibn Sina, CHU Rabat, Maroc
| | | | | | - Ali Iken
- Service d'Urologie A, Hôpital Ibn Sina, CHU Rabat, Maroc
| | | | - Ahmed Jahid
- Service d'Anatomo-pathologie, Hôpital Ibn Sina, CHU Rabat, Maroc
| | - Yassine Nouini
- Service d'Urologie A, Hôpital Ibn Sina, CHU Rabat, Maroc
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12
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Goktug GH, Ozturk U, Sener NC, Tuygun C, Bakirtas H, Imamoglu AM. Transurethral resection of a bladder leiomyoma: A case report. Can Urol Assoc J 2014; 8:E111-3. [PMID: 24554974 DOI: 10.5489/cuaj.1335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Benign mesenchimal tumour of the human bladder is rare. Insulin potentiation therapy mimics malignant tumours both clinically and radiologically. We present a patient we treated with transurethral resection (TUR) only. A 27-year old male patient presented to our clinic with frequency, dysuria and recurrent urinary tract infections. Magnetic resonance (MRI) revealed an endovesical bladder mass of 7 × 8 cm. We performed TUR in the same session for both diagnosis and treatment. The diagnosis was endovesical leiomyoma. Six months to a year after the operation, the MRI did not reveal disease recurrence. Even though TUR is recommended for smaller and endovesical tumours, we believe larger intravesical tumours may also be managed by TUR.
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Affiliation(s)
| | - Ufuk Ozturk
- Diskapi Teaching and Research Hospital, Ankara, Turkey
| | - Nevzat Can Sener
- Ministry of Health, Numune Teaching and Research Hospital, Department of Urology, Adana, Turkey
| | - Can Tuygun
- Diskapi Teaching and Research Hospital, Ankara, Turkey
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13
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Affiliation(s)
- T Elhadari
- Department of Obstetrics and Gynaecology, Torbay Hospital , Torquay , UK
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14
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Epitheliod Leiomyoma of the Bladder: An Unusual Case of Irritative and Obstructive Voiding Symptoms. Case Rep Urol 2012; 2012:759150. [PMID: 22701194 PMCID: PMC3369492 DOI: 10.1155/2012/759150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 04/17/2012] [Indexed: 11/24/2022] Open
Abstract
Epitheloid leiomyoma is a very rare subtype of benign mesothelial tumors of the bladder. A 46-year-old female patient presented to our hospital with prolonged dysuria, frequency, and recurrent urinary tract infections. Bimanual examination revealed a mobile, round mass in bladder. There was a round hyperdense intravesical mass near bladder neck in computed tomography (CT) scan that was compatible with her magnetic resonance imaging (MRI). A well defined 3 × 4 centimeter mass was seen in superolateral part of bladder neck during cystoscopy. The patient underwent partial cystectomy and histopathologic findings confirmed the diagnosis of epithelioid leiomyoma. The patient's followup was uneventful in a period of 2 years. Size and anatomic location of this tumor were major factors that affect on treatment.
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16
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Park JW, Jeong BC, Seo SI, Jeon SS, Kwon GY, Lee HM. Leiomyoma of the urinary bladder: a series of nine cases and review of the literature. Urology 2010; 76:1425-9. [PMID: 20947147 DOI: 10.1016/j.urology.2010.02.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 02/15/2010] [Accepted: 02/15/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To present our experience with 9 cases of bladder leiomyomas and a review of the relevant published data. METHODS During a 13-year period, 9 patients were treated for bladder leiomyoma. Their medical records were retrospectively reviewed, and data, including age, sex, symptoms, tumor size and location, cystoscopy results, radiologic examination findings, method of extirpation, pathology slides, and follow-up results, were analyzed. RESULTS All 9 patients were women, with a mean age of 43.6 years (range 24-65). Of the 9 patients, 5 reported urinary symptoms, 1 presented with gross hematuria, and 3 were asymptomatic. The mean tumor size was 4.2 cm (range 2.4-7). The tumor size was larger in symptomatic patients than in the asymptomatic patients. All tumors were endovesical lesions; 1 patient had a concomitant extravesical tumor. Transurethral resection was performed in 6 patients, partial cystectomy in 2, and enucleation in 1. Microscopically, the tumors were composed of bland, spindle-shaped cells. Recurrence developed in 2 patients. Both patients underwent repeat resection, and no additional recurrence developed. CONCLUSIONS Leiomyoma of the bladder is rare and occurs predominantly in women. The size, rather than the location, of the tumor appeared to be more closely related to the occurrence of symptoms. Surgical excision is the standard approach to diagnosis and treatment.
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Affiliation(s)
- Jong Wook Park
- Department of Urology, Korea Cancer Center Hospital, Seoul, Republic of Korea
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17
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Hong SY, Lee TS, Kim JH. Laparoscopic enucleation of a bladder leiomyoma. J Minim Invasive Gynecol 2009; 16:772-4. [PMID: 19896608 DOI: 10.1016/j.jmig.2009.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 07/07/2009] [Accepted: 07/11/2009] [Indexed: 01/31/2023]
Abstract
Bladder leiomyomas account for less than 0.43% of all bladder tumors, and these comprise about 35% of mesenchymal tumors [1,2]. About 250 cases of bladder leiomyoma have been reported in the English literature to date [3]. A patient may or may not have symptoms, according to the location and size of the leiomyoma. Initial symptoms include urinary frequency, urgency, hematuria, and pelvic pain [4]. Treatment for bladder leiomyoma includes abdominal, vaginal, laparoscopic, or transurethral resection. Herein, we present the first case, to our knowledge, of bladder leiomyoma that was laparoscopically enucleated without cystotomy.
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Affiliation(s)
- Sung Yeon Hong
- Department of Obstetrics and Gynecology, Catholic University of Daegu, Namgu, Korea
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18
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Fletcher SG, Lemack GE. Benign masses of the female periurethral tissues and anterior vaginal wall. Curr Urol Rep 2008; 9:389-96. [PMID: 18702923 DOI: 10.1007/s11934-008-0067-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Due to their rarity, benign masses of the periurethral tissues and anterior vaginal wall are poorly understood. Arriving at the proper evaluation and treatment is challenging because many of these masses have similar presenting signs and symptoms, as well as overlapping differential diagnoses. The literature regarding these lesions mainly consists of level III evidence, mostly involving case reports and series. Clinical management has traditionally been based on established surgical principles and expert opinion. This review presents the pertinent embryologic and anatomic background for these benign masses, as well as other pertinent etiological processes. Furthermore, the most current evidence is reviewed regarding the differential diagnosis, evaluation, and treatment for each mass.
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