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Sakthivel DK, Ragavan M, Bafna S, Tiwari M, Ragavan N. Paraurethral Leiomyoma: A Rare Entity Requiring Extensive Preoperative Counseling and Prompt Management. Cureus 2024; 16:e61684. [PMID: 38975515 PMCID: PMC11226224 DOI: 10.7759/cureus.61684] [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: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Paraurethral leiomyoma is an exceptionally rare benign smooth muscle tumor adjacent to the female urethra, presenting diagnostic challenges due to nonspecific symptoms like urinary obstruction and dysuria. This case report details the clinical presentation, diagnostic workup, and surgical management of a 45-year-old woman with a paraurethral leiomyoma. Diagnosis involved clinical examination, imaging, and biopsy. The mass was excised via a perineal route without urethral injury, confirmed by histopathology. The patient recovered well, voiding without difficulty postoperatively. This case emphasizes the importance of thorough preoperative counseling, advanced imaging, and multidisciplinary collaboration in managing paraurethral leiomyomas.
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Long-term follow up of paraurethral leiomyoma: A case report and literature review. Int J Surg Case Rep 2022; 101:107773. [PMID: 36413893 PMCID: PMC9679484 DOI: 10.1016/j.ijscr.2022.107773] [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] [Received: 08/28/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Paraurethral fibroid is a rare condition. To date, there is no unified protocol to guide long-term follow up in this condition. This study reviewed case reports and summaries published in the last 10 years and focused on the management plans and follow up of patients with paraurethral fibroids. CASE PRESENTATION We report the case of a 44-year-old woman who presented with urinary symptoms. Clinical examination and magnetic resonance imaging revealed an approximately 3 × 3 cm mass which was considered as a paraurethral fibroid. Complete surgical excision was performed. The patient was discharged with no postoperative complications. Histopathology confirmed the diagnosis of a benign leiomyoma. CONCLUSIONS Paraurethral fibroid is a rare condition which can be diagnosed with a high level of certainty based on clinical examination and imaging. A multidisciplinary team which includes experienced radiologists and urogynecologists or urologists who have the expertise to perform vaginal surgery with urethral reconstruction is essential for definitive management. Long-term follow up for expected possible complications is advisable. Further research with a larger number of cases is needed to recommend an evidence-based protocol for management of paraurethral fibroid.
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Maetzold E, Takacs EB. Urethral Pathology in Women. Curr Urol Rep 2022; 23:225-234. [DOI: 10.1007/s11934-022-01109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
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Abstract
Urethral and periurethral masses in women include both benign and malignant entities that can be difficult to clinically differentiate. Primary urethral carcinoma is rare and the optimal treatment modality may vary depending on the stage at presentation. Because cancer-free survival is poor, clinicians shouldhave a high index of suspicion when evaluating a urethral mass. Some benign-appearing urethral masses may be safely observed. Surgical resection is an effective option that should be used based on patient preference and symptoms, and for suspicious lesions.
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Mazhari F, Singh R, Kerketta KA, Pathak N, Singh N. Female paraurethral leiomyoma: a case report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00181-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years.
Case presentation
A 48-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and CT scan and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma.
Conclusions
Paraurethral leiomyoma owing to its rare incidence poses a diagnostic dilemma for the gynecologists. Radiological imaging techniques help in diagnosis. Surgical excision via vaginal route is the treatment of choice. Diagnosis is confirmed by histopathology.
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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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Yang H, Gu JJ, Jiang L, Wang J, Lin L, Wang XL. Ultrasonographic Imaging Features of Female Urethral and Peri-urethral Masses: A Retrospective Study of 95 Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1896-1907. [PMID: 32448559 DOI: 10.1016/j.ultrasmedbio.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to assess the imaging features of urethral and peri-urethral masses on transvaginal or transperineal ultrasound (US) in a cohort of 95 women. In this retrospective study, medical records of 95 female patients with 98 asymptomatic or symptomatic urethral and peri-urethral masses were retrospectively reviewed. Data regarding patient demographic characteristics, symptoms, signs, imaging features on 2-D and 3-D transvaginal or transperineal US, diagnostic tests and physical and intra-operative findings were extracted. The US imaging features and clinicopathologic characteristics of each urethral or peri-urethral mass were compared. On ultrasound, 39 masses (in 39 patients) were diagnosed as urethral diverticula, which manifested mostly as complex cystic masses (24/39, 61.5%); 35 masses (in 33 patients) were diagnosed as para-urethral cysts, which manifested mostly as simple cystic masses (19/35, 54.3%); 13 hypo-echoic solid masses (in 12 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral leiomyomas; hypo-echoic or heterogeneous solid masses (in 8 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral caruncles, including one complicated by malignant transformation; solid masses with mixed echogenicity (in 2 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral squamous cell carcinoma or adenocarcinoma, and a hypoechoic solid mass (in one patient) with blood-flow signals on color Doppler imaging was diagnosed as urethral condyloma associated with human papillomavirus infection. This study confirmed transvaginal or transperineal 2-D and 3-D ultrasonography to be a valid, non-invasive, cost-effective diagnostic modality for the differential diagnosis of urethral and periurethral masses.
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Affiliation(s)
- Hua Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Jiao-Jiao Gu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Luo Jiang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Jie Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Lin Lin
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Xin-Lu Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China.
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Braga A, Soave I, Caccia G, Regusci L, Ruggeri G, Pitaku I, Bassi V, Papadia A, Serati M. What is this vaginal bulge? An atypical case of vaginal paraurethral leiomyoma. A case report and literature systematic review. J Gynecol Obstet Hum Reprod 2020; 50:101822. [PMID: 32492525 DOI: 10.1016/j.jogoh.2020.101822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
AIM Vaginal paraurethral leiomyomas are uncommon benign tumors of the female genitourinary tract. We report a case of anterior vaginal paraurethral leiomyoma. Furthermore, we performed a systematic review of the literature to provide information that can help the physicians in the diagnosis and management of women with this rare pathology. METHODS A case of anterior vaginal paraurethral leiomyoma in 53-year-old, primiparous, caucasian woman with history of pelvic pressure, vaginal bulging and overactive bladder symptoms, was described. Furthermore, a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed between January 1, 2000 to Dec 30, 2019. Only articles that reported cases of vaginal or paraurethral leiomyoma (b) case series and case reports with literature review were included. RESULTS we screened a total 2281 records; 70 articles published from 2000 to 2019 were included. CONCLUSION Vaginal paraurethral leiomyoma is a rare benign tumor of the vagina with a wide spectrum of symptoms and good prognosis. The recurrence and transformation into malignant condition are rare. Histopathological examination is the gold standard for diagnosis, but MRI and US can be help to define the size and localization of the tumor. Management requires surgical vaginal excision in the majority of cases; however, abdominal approach could be considered when it is large and located high in the vagina.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland.
| | - Ilaria Soave
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland; Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Luca Regusci
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giovanni Ruggeri
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Ilvana Pitaku
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Valerio Bassi
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, EOC - Civico Hospital, Università della Svizzera Italiana, Lugano, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Viester MD, Schotman M. Three female patients with a periurethral mass: from various complaints to rare pathology. BMJ Case Rep 2020; 13:13/4/e234086. [PMID: 32276998 DOI: 10.1136/bcr-2019-234086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this case report, we will discuss three cases of women diagnosed with a periurethral mass. The specific diagnosis of a periurethral mass can vary and includes rare diseases. Therefore, they provide a challenge to medical professionals. All patients underwent diagnostic evaluation with cystoscopy and pelvic MRI followed by surgical removal. Based on the MRI and pathology report, different diagnoses were made for each patient. The three diagnoses will be discussed: subpubic cartilaginous cyst, leiomyoma and clear cell adenocarcinoma of the urethra. Our case report is useful for other medical professionals, and they can evaluate how to optimal approach a periurethral mass.
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Affiliation(s)
| | - Mirjam Schotman
- Department of Urology, Meander MC, Amersfoort, The Netherlands
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Harada K, Ishikawa Y, Fujiwara H, Ishihara G. Female paraurethral leiomyoma successfully excised through a vaginal approach: A case report. J Obstet Gynaecol Res 2018; 44:1174-1176. [DOI: 10.1111/jog.13641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ko Harada
- Department of Obstetrics and Gynecology; Mitoyo General Hospital; Kagawa Japan
- Department of General Medicine; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Yoko Ishikawa
- Department of Obstetrics and Gynecology; Mitoyo General Hospital; Kagawa Japan
| | - Haruna Fujiwara
- Department of Obstetrics and Gynecology; Mitoyo General Hospital; Kagawa Japan
| | - Go Ishihara
- Department of Obstetrics and Gynecology; Mitoyo General Hospital; Kagawa Japan
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Chung ASJ, McCammon KA. Outlet Procedures in Female Cancer Survivors for the Treatment of Stress Incontinence: Differences in Indications, Technique, and Outcome for the Cancer Survivor. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Imaging findings of paraurethral leiomyoma. Diagn Interv Imaging 2017; 98:173-175. [DOI: 10.1016/j.diii.2016.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/17/2016] [Accepted: 03/30/2016] [Indexed: 11/17/2022]
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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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