0022-5347 ;ssn401-0142$2.oo;o Vol. 140; July
THE JOURNAL OF UROLOG'Y
Copyright© 1988 by The Williams & Wilkins Co.
Printed in U.S.A.
LEIOMYOMA OF THE BLADDER CAUSING URETHRAL AND UNILATERAL URETERAL OBSTRUCTION: A CASE REPORT M, A. BAZEED
From the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
We report a case of a vesical leiomyoma that obstructed not only the ureter but also the urethra. This entity is rare and to our knowledge it has not been described previously in the urological or gynecological literature. (J. Ural., 140: 143-144, 1988) When dealing with urinary tract obstruction, it is wise to think of rare, in addition to the common, causes.
mality. An excretory urogram (IVP) demonstrated a normal right kidney, while the left kidney did not excrete contrast material. A cystogram showed obstruction of the bladder by a large smooth rounded filling defect to the left side (fig. 1). Ultrasonography revealed marked hydronephrosis of the left kidney. A radioisotope renogram showed a normal right kidney but the left kidney was flat with a differential clearance of O mL per minute. Panendoscopy demonstrated an elongated and compressed urethra. A large tumor was noted originating from the left lateral wall of the bladder, which was covered by intact mucosa. Random punch biopsies of the bladder mucosa showed nonspecific cystitis. Laparotomy via a left paramedian transperitoneal approach was performed. The left kidney was hydronephrotic with thin parenchyma and the ureter was dilated until it disappeared behind a large mobile hard mass in the bladder. There was no connection between the mass and the uterus or
A 19-year-old woman presented with severe difficulty of micturition and frequency 3 years in duration. General physical
FIG. 1. IVP shows no excretion of contrast material by left kidney and smooth filling defect in bladder that appears to be obstructed.
examination was normal. Bimanual rectal examination revealed a firm huge pelvic mass that was separated from the uterus. Catheterization yielded 300 ml. residual urine. All laboratory investigations were within normal limits. A film of the kidneys, ureters and bladder showed no abnorAccepted for publication October 30, 1987.
FIG. 2. Histological section of removed mass reveals classical appearance of fibroleiomyoma. H & E, reduced from X250.
BAZEED AND ABOULENIEN
cervix. The bladder was opened and its mucosa was intact. An incision was made in the mucosa and the tumor was enucleated. Left nephroureterectomy was performed. The bladder was repaired and a urethral catheter was left indwelling. Examination of the removed specimen showed a large 12 X 6 x 4 cm. ovoid encapsulated mass. The cut surface was whitish in color with wavy bundles and a whorled appearance. Microscopic examination revealed the classical characteristics of a fibroleiomyoma, that is proliferation of spindle cells, muscular and fibrous tissue with fibrous stroma and no evidence of malignancy (fig. 2). Convalescence was uneventful and the voiding pattern was satisfactory.
reported in both sexes. 1- 4 Knoll and associates reported 5 cases in which leiomyoma was discovered incidentally and 5 other cases that were symptomatic. 3 Patient age ranged from 49 to 58 years. Recently, a vesical leiomyoma originating from the bladder neck of a 40-year-old woman causing repeated attacks of retention was described by Kuber and Pflanzl. 4 Our patient had a vesical leiomyoma that compressed not only the pelvic ureter but also the urethra and bladder neck, causing marked pressure symptoms on the ureter and kidney and obstruction of the bladder neck. We believe that the urologist as well as the gynecologist should keep in mind such a benign condition regardless of patient age.
1. Bittard, M., Carbillet, J.-P., Paoletti, G. and Pages, C.: Les leio-
The most common benign pelvic tumor in female subjects is leiomyoma, which is referred to as myoma or fibroid. Myoma is rare in patients less than 20 years old, with a slow rate of growth (3 years to reach the size of an orange). Most fibroids are located within the uterus. About 1 to 2 per cent of fibroids are confined to the cervix, especially in the supravaginal portion. Leiomyoma occurs rarely in the bladder with only 166 cases
myomes du bas appareil urinaire chez la femme: a propos de deux observations. J. Urol. Nephrol., 83: 226, 1977. 2. Vargas, A. D. and Mendez, R.: Leiomyoma of bladder. Urology, 21: 308, 1983. 3. Knoll, L. D., Segura, J. W. and Scheithauer, B. W.: Leiomyoma of the bladder. J. Urol., 136: 906, 1986. 4. Kuber, W. and Pflanz!, W.: Leiomyoma of the bladder neck-cause of recurrent urinary retention in a 47 year old woman. Akt. Urol., 18: 93, 1987.