Urethral leiomyoma: a rare case of voiding difficulty

A urethral leiomyoma presenting with dysuria: A rare case report

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.

Long-term follow up of paraurethral leiomyoma: A case report and literature review

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.

Laparoscopic management of a large urethral leiomyoma

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.