Urethral pyogenic granuloma in an adult patient: Presentation and management

Pyogenic granulomas (PGs) are benign vascular tumors that are commonly found on cutaneous and mucosal surfaces. However, mucosal PGs are rarely found in the urogenital tract. Here, we report a case of PG arising from the urethra in a 68 year-old female. The mass was found during evaluation for vaginal prolapse, excised, and classified as PG by histopathology. Urethral PG has been rarely reported in adults and should be considered in the differential for patients presenting with urethral mass.

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.

Urethral Masses

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.

Giant primary vaginal tubulovillous adenoma: A case report and review of literature

Primary adenomas are common in the gastrointestinal tract but exceedingly rare on the periurethral surface and vagina. The pathogenesis remains unknown but vaginal adenomas are hypothesized to arise from vaginal adenosis or embryonic cloacal remnants and possess malignant potential. We present a case of a large primary vaginal tubulovillous adenoma in an eighty-one-year-old, likely diethylstilbestrol naïve patient. To the best of our knowledge the patient's 7.4 x 4.5 × 1.4 cm primary vaginal tubulovillous adenoma is the largest ever reported in literature.

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Primary vaginal adenomas in diethylstilbestrol naïve patients are exceedingly rare

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Vaginal adenomas have malignant potential and must be fully resected

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There is no consensus on management of primary vaginal adenomas

Circumferential urethral diverticulum: a surgical conundrum

INTRODUCTION AND HYPOTHESIS

Excision of a circumferential diverticulum may be challenging as its extension into the dorsal aspect of the urethra makes access complicated.

METHODS

A 69-year-old woman with a history of Stage 3C ovarian cancer on chemotherapy presented with a 3-week history of severe dysuria and suprapubic pain. T2-weighted pelvic magnetic resonance imaging (MRI) showed a circumferential diverticulum extending over the dorsal midurethra without evidence of urethral communication. As conservative measures including bladder instillations failed, she underwent surgical excision of this multilocular circumferential diverticulum. The diverticulum was identified and excised in segments. To achieve optimal excision, we incised around and dorsal to the urethral meatus into the retropubic area. Finally, a communicating tract from the ventral loculation of the diverticulum to the urethra was identified. The communication was obliterated, and the urethra was repaired in two layers and reinforced with a fibromuscular flap. The fluid tight seal was confirmed by retrograde filling of the bladder and cystourethroscopy.

RESULTS

The patient was symptom free at 6-week and 6-month visits.

CONCLUSION

This video highlights the steps required to successfully excise a complex circumferential diverticulum that extends over the dorsal midurethra and has a communication with the urethral lumen.

Urethral Prolapse: A Case Series and Literature Review

Introduction and Hypothesis

Urethral mucosal prolapse is most frequently seen in children and postmenopausal women, and extremely rare in young adult patients. In this context, we aim to describe our experience with this condition and compare our findings with the literature.

Methods

We reviewed the medical records of our outpatient micturition disorders clinic (between August 2014 and April 2017) for patients with a diagnosis of urethral mucosal prolapse, seeking to evaluate their demographic characteristics, presenting complaints, treatment, and outcomes.

Results

We found 12 cases of urethral mucosal prolapse, including a mother and daughter and a reproductive-aged patient. Presenting symptoms included bleeding, urinary retention, partially thrombosed mucosa, and pain. Misdiagnosis was common and caused treatment delay, even in some very symptomatic patients.

Conclusion

Urethral mucosal prolapse is a readily diagnosed condition and often associated with complications in our series. Proper diagnosis is key to successful, timely treatment. Descriptive studies such as this are important to raise awareness of this diagnosis and improve patient care.

Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst?

PURPOSE

To evaluate magnetic resonance imaging findings that differentiate among periurethral bulking agents (primarily collagen), urethral diverticulum, and periurethral cyst.

METHODS

We searched our radiologic database retrospectively from 2001 to 2017 for periurethral cystic lesions, identifying a total of 50 patients with 68 lesions. Final diagnoses in 68 lesions were bulking agents (27), urethral diverticula (29), and periurethral cysts (12). Two abdominal radiologists, blinded to clinical history, independently evaluated T1, T2, and post-contrast images. The readers assessed number, morphological features, location, connection to urethra and mass effect, signal intensity, and enhancement for each lesion. Fisher exact test and logistic regression analysis were performed for each univariate significant feature. The operative and pathologic reports were the reference standard.

RESULTS

Magnetic resonance imaging features found more often in bulking agents versus urethral diverticulum were multiple lesions (P = 0.011), upper or upper-mid-urethral location (P ≤ 0.0001), lack of internal fluid/fluid level (P = 0.002), no urethral connection (P = 0.005), T1 isointensity, and T2 mild hyperintensity compared to muscles but lower T2 signal than urine (P < 0.0001). Most cases of urethral diverticula and periurethral cysts were detected at mid- and lower urethra. Urethral diverticula were larger than bulking agents and periurethral cysts (P = 0.005 and P = 0.023) (mean diameter = 24, 16, 15 mm, respectively). Most bulking agents (93%) and urethral diverticula (90%) showed mass effect on urethra, while periurethral cysts (75%) did not (P < 0.0001).

CONCLUSION

Signal intensity and lesion characterization on magnetic resonance imaging can significantly differentiate bulking agent from urethral diverticulum and periurethral cyst. Radiologists should consider differential diagnosis of a bulking agent, especially when distinguishing characteristics described here are present to prevent incorrect diagnosis and ultimately unnecessary surgical intervention.