Sonographic findings of acute urinary retention secondary to an impacted pelvic mass

Maternal posture-physiology interactions in human pregnancy: a narrative review

There are several well-known medical conditions in which posture and gravity interact with natural history, including pregnancy. In this review, we provide a comprehensive overview of interactions between maternal posture and maternal physiology and pathophysiology at rest during pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 644 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We present a narrative review of the resulting literature and highlight discrepancies, research gaps, and potential clinical implications. We organize the results by organ system and, commencing with the neurological system, proceed in our synthesis generally in the craniocaudal direction, concluding with the skin. The circulatory system warranted our greatest and closest consideration-literature concerning the dynamic interplay between physiology (heart rate, stroke volume, cardiac output, blood pressure, and systemic vascular resistance), pathophysiology (e.g., hypertension in pregnancy), and postural changes provide an intricate and fascinating example of the importance of the subject of this review. Other organ systems discussed include respiratory, renal, genitourinary, gastrointestinal, abdominal, and endocrine. In addition to summarizing the existing literature on maternal posture-physiology interactions, we also point out gaps and opportunities for further research and clinical developments in this area. Overall, our review provides both insight into and relevance of maternal posture-physiology interactions vis à vis healthcare's mission to improve health and wellness during pregnancy and beyond.

Acute Urinary Retention Due to Incarcerated Uterus With Adenomyosis: A Case Report

Acute urinary retention caused by uterine incarceration due to adenomyosis is a rare phenomenon with limited documented cases. This report details the case of a 38-year-old female with acute urinary retention. A pelvic MRI revealed an enlarged retroverted uterus with a mass on the posterior left of the myometrium, indicative of adenomyosis. The size and anatomical location of the mass suggested uterine incarceration with direct pressure on the urinary bladder neck, leading to urinary retention. The patient underwent total abdominal hysterectomy, bilateral salpingectomy, and adhesiolysis. Subsequent follow-ups at one and three months post-surgery showed the resolution of urinary symptoms, underscoring the importance of considering adenomyosis as a potential cause of urinary retention in women with lower urinary tract symptoms. Timely recognition and appropriate intervention are crucial for mitigating complications and improving outcomes in these patients, as illustrated in this case.

Uterine incarceration: a rare diagnosis in non-pregnant women

Uterine incarceration (UI) is a rare complication in non-pregnant women. A woman in her 50s presented to the emergency department with acute urinary retention and paresis of the right inferior limb. A neurological exam suggested a decrease in the right lower limb strength. On gynaecological exam, the cervix was displaced anteriorly and the cul de sac was obliterated with a pelvic mass. CA 19.9 and CA 125 levels were increased. The MRI of the pelvis confirmed an elongated and anteriorly displaced cervix compressing the urethra and the vesical neck due to a uterine mass. A diagnosis of UI was made and an abdominal hysterectomy with adhesiolysis was suggested as the treatment option. Six months after surgery the patient had no urinary complaints and the neurological exam was normal. UI should be considered in women with urinary and neurological symptoms. A delay in diagnosis may lead to significant morbidity.

Ovarian mucinous cystadenoma causing acute urinary retention

Acute urinary retention rarely occurs in women, and is only infrequently caused by a pelvic mass. We describe a case of acute urinary retention caused by a large ovarian mucinous cystadenoma. Point of care ultrasound characterized and localized the lesion, while computerized tomography demonstrated the anatomic distortions resulting in urinary retention. The patient's symptoms resolved immediately following a laparoscopic right salpingo-oophorectomy with complete tumor removal.

Female detrusor underactivity: Two uterine leiomyoma cases

INTRODUCTION

Female urinary retention is rare.

CASE PRESENTATION

Case 1, a 35-year-old nulliparous woman, and case 2, a 47-year-old nulliparous woman, had transient urinary retention. A urodynamics revealed increased bladder sensation in case 1 and detrusor underactivity with a large post-void residual in cases 1 and 2. Both women had a uterine leiomyoma of >10 cm in diameter. Soon after extraction of the tumor, retention episodes disappeared completely in case 1.

CONCLUSION

Although rare, uterine leiomyoma should be listed as a cause of female detrusor underactivity.

Surgical management of an incarcerated uterus in a gynecological patient: A case report

Uterine incarceration is most often described as occurring in pregnancies. Presenting with severe pelvic pain, urinary retention, and in some cases spontaneous abortion, this complication often arises at 12–15 weeks of gestational age. Although usually considered an obstetrical complication, uterine incarceration can occur in nongravid females. This case report presents a gynecological patient with acute urinary retention secondary to uterine incarceration. The patient chose surgical management, and surgery provided immediate symptomatic relief. Our case highlights an uncommon etiology of acute urinary retention and demonstrates the importance of considering the diagnosis of uterine incarceration in nongravid as well as gravid females.

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Uterine incarceration occurs in first or second trimester and can result in miscarriage;

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In nongravid patients, it presents with pain and urinary retention;

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Interventions are more aggressive in nongravid patients

A Case of Female Acute Urinary Retention Presenting to the ED

Introduction

Acute urinary retention is a rare occurrence in women necessitating further investigation. Potential underlying causes may be broadly classified into obstructive, neurological, pharmacological, and psychogenic categories.

Case

A 36-year-old nulliparous female presented to the Emergency Department with a two-day history of acute urinary retention. Point-of-care ultrasonography and CT scan imaging confirmed the presence of a large uterine mass causing compression of the bladder. The acute retention was relieved with urethral catheterization. A Uterine leiomyoma was confirmed on histology after hysterectomy.

Discussion

Once the acute urinary retention has been relieved by insertion of a urethral catheter, the underlying cause of the obstruction must be determined. Although uterine leiomyoma is a fairly common finding in the general population, it is an extremely rare cause of acute urinary retention in women with just a handful of reported cases in the literature.

Diagnosis of Urethral Stricture on Dynamic Voiding Transvaginal Sonourethrography

Urethral stricture in a woman is a difficult diagnosis to establish due to its rarity and clinical resemblance to bladder outlet obstruction. Imaging is used to differentiate between the various bladder, urethral, and extrinsic causes of obstruction with the standard voiding cystourethrographic examination but with little success in female patients. The following case presents complete urethral stricture in a woman, which was detected with transvaginal sonography. Transvaginal sonography is not a common modality used to assess female urethral anatomy. The urinary bladder is comfortably distended, unlike in transvaginal sonography for gynecologic indications. Urethral evaluations can be carried out while the patient strains in an attempt to void the urinary bladder. As the normal proximal urethra distends with the antegrade flow of urine during straining, the urethral caliber and wall can be evaluated to assess the level, cause, and severity of obstruction. Sonography provides the unique ability to capture a dynamic assessment of the urethra for a reasonable length of time, without the use of ionizing radiation.

Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series

Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options.

Transvaginal Resection of a Bladder Leiomyoma Misdiagnosed with a Vaginal Mass: A Case Report and Literature Review

Bladder leiomyoma is a rare benign tumor and it could be easily misdiagnosed with many other pelvic diseases, especially obstetrical and gynecological diseases; abdominal, laparoscopic, and transurethral resection of bladder leiomyoma have been reported. Herein, we present a case of bladder leiomyoma misdiagnosed with a vaginal mass preoperatively; the mass was isolated, enucleated from the bladder neck, and removed transvaginally; to the best of our knowledge, this is the first case of intramural leiomyoma of bladder neck that has been enucleated transvaginally only without cystotomy.

Urinary retention and uterine leiomyomas: a case series and systematic review of the literature

Uterine leiomyomas are underrecognized as a cause of acute urinary retention (AUR) in women. The objective of this study was to present a case series and systematic review of the literature, to elucidate the pathogenesis of leiomyoma-related AUR, and to suggest management strategies. We included patients presenting with AUR and uterine leiomyomas at our institution between January 2011 and December 2013. Further, we systematically searched the Cochrane Library (from 1898 to June 2014), EMBASE (from 1947 to June 2014), and MEDLINE (from 1946 to June 2014) databases according to the PRISMA guidelines. A total of six patients with AUR and leiomyomas presented to our institution. Through the systematic review, another 31 cases of AUR were identified. Combined patient ages ranged from 25 to 75 years. Uterine size ranged from 10 to 22 weeks on physical examination and from 5.5 to 26 cm on imaging. The dominant leiomyoma size ranged from 5.7 to 22.4 cm. Significant risk factors were posterior or fundal leiomyoma position and the presence of a retroverted uterus. Proposed mechanisms for leiomyoma-related AUR include proximal urethra or bladder-neck compression, premenstrual pelvic congestion, vascular steal effect, and compression of pudendal or sacral nerves. Patients were treated with hysterectomy, myomectomy, uterine fibroid embolization, hormones, or by conservative management alone. In the absence of neurologic disorders or other risk factors, neither urodynamic studies nor neuromuscular testing seem to contribute to diagnosis or guide management in women with uterine leiomyomas and AUR. Patients presenting to gynecologists seem to experience shorter times to diagnosis and treatment compared with other specialties. It is essential to recognize leiomyomas as a potential cause of AUR in order to reduce unnecessary testing and delays in diagnosis and management.

A prospective observational study of lower urinary tract symptoms before and after surgical removal of a large pelvic mass

INTRODUCTION AND HYPOTHESIS

The aim of this study was to assess the impact of the surgical removal of a large pelvic mass on preexisting lower urinary tract symptoms (LUTS) and function.

METHODS

This was a prospective study of planned surgical management of women with a large pelvic mass (uterine or ovarian mass ≥ 7 cm on pelvic ultrasound) who also reported bothersome LUTS (urinary frequency, urgency, incontinence and/or voiding dysfunction). Assessment included structured history and examination, completion of the short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), a 3-day bladder diary and multi-channel urodynamics (UDS) at baseline and 3 months postoperatively. The primary outcome was a reduction in the total mean scores of the UDI-6 and IIQ-7. Secondary outcomes were a change in bladder diary and UDS parameters. Univariate analysis and paired t test were used in the statistical analysis.

RESULTS

Twenty-nine women underwent surgical management of a pelvic mass. The most common preoperative urinary symptom was urinary urgency. Two women had overt urinary retention that resolved completely postoperatively. All women completed pre- and postoperative UDI-6 and IIQ-7. The UDI-6 and IIQ-7 demonstrated a highly significant reduction in the mean total scores of 66%, signifying symptom and quality of life improvement. Bladder diary parameters showed significant reductions in daytime urinary frequency and stress incontinence episodes. Maximum and average voided volumes increased by a mean of 60 ml. Only 14 women underwent postoperative UDS.

CONCLUSIONS

This study provides evidence that the majority of LUTS present preoperatively improve significantly or resolve completely following removal of a ≥ 7-cm pelvic mass.

Treatment of urinary retention caused by uterine leiomyoma with a gonadotropin-releasing hormone agonist: case report and review

CASE

We present a case of a symptomatic uterine leiomyoma presenting with recurrent urinary retention that was conservatively managed with a gonadotropin-releasing hormone agonist. As far as we know, this is the first reported case of a successful treatment by gonadotropin-releasing hormone agonist. We also compare other approaches to treatment of urinary retention secondary to uterine leiomyoma found in literature.

CONCLUSION

Gonadotropin-releasing hormone agonists can be offered to the patient as a potential, successful nonsurgical option in select cases.

The clinical characteristics of uterine tumor-related bladder outlet obstruction

INTRODUCTION AND HYPOTHESIS

The aim of this study was to assess the clinical characteristics of bladder outlet obstruction caused by uterine tumors.

METHODS

We collected and analyzed data for eight patients who visited our urologic clinic due to voiding difficulty or acute urinary retention in the early morning and whose final, corroborated diagnoses were uterine tumors. Another eight patients with uterine tumor but without voiding symptoms were included as the controls.

RESULTS

In group 1, six patients experienced acute early-morning urinary retention and two patients experienced severe early-morning voiding difficulty. This voiding difficulty lessened significantly during the day. All patients in group 1 received urodynamic studies which indicated a high detrusor voiding pressure (median, 28.5 cmH(2)O). The uroflowmetry test performed during the day showed a good maximal flow rate (median, 27 ml/s). Seven patients in group 1 who underwent surgery no longer had early-morning emptying symptoms. All tumors were located in the posterior uterine wall, in contrast to the control group whose tumors were located in fundus or anterior wall.

CONCLUSIONS

Early-morning urinary retention or voiding difficulty can be considered as an important symptom of a uterine tumor obstructing the bladder outlet.

Acute urinary retention caused by endometrial carcinoma with large cystic cervix

INTRODUCTION

Several pelvic masses have been known to cause urinary retention due to a mass effect with the bladder being obstructed secondary to compression of the urethra or bladder neck.

MATERIALS AND METHODS

We report the extremely rare case of endometrial carcinoma with an enlarged cystic cervix which resulted in acute urinary retention. A 92-year-old woman was referred for acute urinary retention. Vaginal ultrasound revealed a 70 × 70 × 65 cm-sized cystic lesion in the cervix. Voiding became normal immediately after the incision and drainage of the mass. Ultrasound performed after the incision revealed a hyperechogenic mass with a honeycomb appearance in the uterine cavity. Endometrial biopsy revealed well-differentiated adenocarcinoma of the endometrium. Total hysterectomy and bilateral salpingo-oophorectomy was performed.

CONCLUSION

The possible existence of endometrial carcinoma should be considered when the enlargement of cervix is clinically suspected in an elderly woman even if there is no vaginal discharge or bleeding.

Objective cure of urinary retention following laparoscopic hysterectomy for a large uterine fibroid

Acute urinary retention (AUR) in women is not uncommon. Many reports have been published discussing the possible theories and pathogeneses of this condition. AUR induced by uterine fibroid is a rare entity that has been mentioned only in case reports. All the reported cases focused mainly on the different approaches for fibroid management. In this study, we present a 52-year-old female with recurrent episodes of urinary retention that was related to periods of menstruation. Pelvic magnetic resonance imaging revealed a markedly enlarged uterus with multiple fibroids. The patient had laparoscopic hysterectomy with postoperative resolution of patient's symptoms and improved uroflow studies. This is the first article that proves the cure of AUR following hysterectomy using an objective tool.

Acute urinary retention caused by a large impacted leiomyoma

OBJECTIVE

Both acute urinary retention (UR) and impacted pelvic mass are rare events in women. We report a case of complete UR caused by impaction of a large myomatous uterus.

CASE

A 36-year-old virgin woman presented to the outpatient clinic of our department for further investigation of her pelvic mass. Abdominal sonography showed a solid, hypoechoic, 11 x 9 cm mass filling the pelvic cavity. After sonography, the patient was unable to void second time in that week and a Foley catheter had to be re-inserted. Laparotomy revealed a large myoma filling the entire pelvic cavity. The uterus-mass complex was impacted in the pelvis, leiomyoma had been compressing the uterus into the base of the pelvis. Myomectomy was performed.

CONCLUSION

It seems that complete UR associated with pelvic mass is usually a sign of pelvic impaction of the mass.

Obstructive nephropathy and chronic kidney disease secondary to uterine leiomyomas

We present three cases of chronic kidney disease secondary to large fibroid uterus. The difficulties experienced in their clinical management and a review of literature is outlined.

Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature

Approximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans- or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two- and three-dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed.

Uterine fibroid embolization for patients with acute urinary retention

Acute urinary retention due to uterine fibroids is rare. In reported cases, hysterectomy and myomectomy have been the recommended therapies. Herein, the authors describe two patients with acute obstructive urinary retention who experienced immediate improvement and the ability to spontaneously void after uterine fibroid embolization. The rapidity of response and the nonsurgical nature of this therapy suggest that it may be used as the first-line therapy for this rare event.

Urinary retention due to mesenteric cyst: An extremely unusual presentation of a rare complication

Mesenteric cysts are rare intra-abdominal masses, presenting with various clinical signs and symptoms. Mesenteric cysts presenting with a sudden onset of urinary retention is extremely rare. There are no cases reported in the English literature. Here, we report a very rare case of urinary retention, due to mesenteric cyst in a 19-year-old man. The patient presented with abdominal distention with a sudden onset of urinary retention. Ultrasonography and computed tomography scan of the abdomen revealed a huge cystic mass above the bladder that was completely separated from the kidney and bladder. The cyst was removed surgically. The patient experienced no urological difficulty after the surgery. Histological examination confirmed the diagnosis of a mesenteric cyst.

Intermittent urinary retention secondary to a uterine leiomyoma

Urinary retention rarely affects reproductive-age women. In obstructive retention, the source must be determined and then removed to allow the patient to void normally. The most common causes of obstructive retention are gynecologic surgery and pelvic masses. Two women with intermittent urinary retention were evaluated in our clinic. Case 1 was a 48-year-old patient who voided frequently to avoid urinary retention. She had an ultrasound showing a large posterior leiomyoma. Case 2 was a 49-year-old female who presented with urinary retention during her menses. Magnetic resonance imaging result showed a large posterior leiomyoma deflecting the cervix anteriorly. Both women's urinary retention completely resolved after a total abdominal hysterectomy. Uterine leiomyomas may be the cause of urinary retention in reproductive-age females without other etiologies.

Two cases of female acute urinary retention caused by an impacted pelvic mass

We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.

Two- and three-dimensional sonographic findings in a case of distal urethral obstruction due to a paraurethral tumor

The cause of bladder outlet obstruction in women may be categorized generally into two types, functional and anatomical. On ultrasonography, the urethra appears as a tubular structure with a central echolucent part and surrounding hyperechogenic structures. Morphological changes in the echolucent portion of the urethra have been reported to be associated with voiding dysfunction. We present a case of distal urethral obstruction secondary to metastatic paraurethral adenocarcinoma. Three-dimensional sonography clearly demonstrated the configuration of the metastatic tumor and its spatial orientation in association with distal urethral obstruction.