Fistula between degenerated uterine leiomyoma and the bladder: case report

Most common reason for the vesicouterine fistula is a cesarean section; no cases were reported of degenerated uterine leiomyoma communicating with the urinary bladder. We report a case of fistulous communication between the degenerated leiomyoma and the bladder. The patient's initial clinical presentation was consistent with recurrent UTI. She underwent multiple examinations including cystoscopy, cystouretrography, retrograde pyeolography, and MRI. The ultimate treatment was an exploratory laparotomy and en-block resection of the bladder wall, fistula tract, and degenerated leiomyoma. Fistula can develop between the bladder and degenerated leiomyoma and could be one of the reasons for the chronic pelvic pain and dysuria.     

壁间型膀胱平滑肌瘤十例患者诊治经验的初步探讨

目的通过对壁间型膀胱平滑肌瘤的诊疗进行回顾性分析,初步探讨其临床诊疗方式。方法回顾性分析2010年1月至2019年1月于徐州医科大学附属医院泌尿外科行手术治疗壁间型膀胱平滑肌瘤10例患者资料。其中男性1例,女性9例,年龄33~51(44±6)岁。其中5例患者以膀胱刺激症状为主要临床表现,1例患者以下腹痛为主要表现,还有4例患者无明显临床症状,患者发病时间1周至2年,平均4.9个月。患者泌尿系彩超检查发现膀胱壁上形态规则、表面覆盖黏膜高回声的低回声包块。CTU检查为膀胱壁均质样实性肿块,边界清楚、光滑,无侵蚀表现,膀胱壁走形自然,且壁周脂肪间隙清晰,膀胱内可见充盈缺损。膀胱镜检查可见瘤体表面黏膜常完整连续,可见局部稍向膀胱内隆起。根据患者肿瘤部位、大小,10例患者分别采用经尿道平滑肌瘤剜除术和腹腔镜下平滑肌瘤剜除术,3例患者术中冰冻切片示:膀胱平滑肌瘤。结果10例患者中有临床症状者:其中5例以膀胱刺激症状为主诉的患者术后症状明显缓解,表现为下腹部疼痛症状的患者术后腹痛症状消失,所有患者术后均未发生并发症,术后随访4~24个月(平均16个月)均未见肿瘤复发且未诉漏尿等常见并发症。结论泌尿系彩超,CTU等影像学检查与膀胱镜相结合是诊断壁间型膀胱平滑肌瘤的主要手段,经尿道肿瘤剜除术、腹腔镜下肿瘤剜除术是治疗壁间型膀胱平滑肌瘤安全有效的手术方式且预后较好。     

Leiomyoma of the urinary bladder with bladder stone

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature.     

腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的临床体会

目的探讨腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的疗效及安全性。 方法回顾性分析2010年9月到2016年11月腹腔镜治疗膀胱浆膜下平滑肌瘤8例患者资料,其中男性5例,女性3例,年龄31~65（平均47±10）岁,主诉为膀胱刺激症状者3例,下腹痛者2例,无临床症状、体检发现者3例。病程1周至3年,平均21个月。所有患者术前均行尿常规、超声、CT尿路成像（CTU）、膀胱镜等检查,尿常规均正常。 结果8例患者均行腹腔镜膀胱肿瘤剜除治疗且完整剜出肿块,快速病理均示平滑肌瘤,术后病理示膀胱平滑肌瘤,其中7例患者因膀胱黏膜完好未予缝合。手术时间40~70（53±10）min,术中出血20~50（34±10）ml,术后随访3~12个月（平均7.5个月）均未见肿瘤复发且未诉尿瘘等常见并发症。 结论对于浆膜下型膀胱平滑肌瘤,腹腔镜下膀胱肿瘤剜除术是安全、有效的手术方法。     

Pelvic plexus compression due to a uterine leiomyoma in a woman with acute urinary retention: a new hypothesis

Acute urinary retention (AUR) in women is an uncommon occurrence described by the International Continence Society (ICS) as a painful, palpable, or perceptible bladder when the patient is unable to pass urine. Contrarily to men, AUR in women is not usually due to any obstructive process. Neurologic causes are the most common reason for AUR in reproductive-age women. A few case reports have been published concerning women suffering from gynecological pathology and AUR, and they propose extrinsic compression of the urinary tract. In the case we report, AUR pathophysiology was compression of the pelvic plexus by a giant uterine leiomyoma. An electromyogram displayed motor polyradiculopathy of S1 and S2 nerve roots, and the patient was unable to urinate due to an uncontractible bladder.     

Case series – Prioritizing bladder-sparing treatments in patients with urinary tract leiomyoma: A report of three cases and updated literature review

Urinary tract leiomyomas are rare, benign mesenchymal tumors that are traditionally treated with complete surgical excision. We present three cases of urinary tract leiomyoma — two located in the bladder and one in the ureter. Both bladder leiomyomas were treated with transurethral resection of bladder tumor (TURBT) with no evidence of recurrent disease, while the upper tract leiomyoma was managed with surveillance by patient preference, which to our knowledge, has not been previously described. The ureteral leiomyoma has remained stable at five years followup from initial diagnosis. Given the benign nature of leiomyomas and the overall low recurrence rate reported in the literature, bladder-sparing options should be emphasized when feasible, with active surveillance potentially applicable for highly select patients.

KEY MESSAGES

• Leiomyomas are benign mesenchymal tumors that rarely affect the bladder and are even less frequently seen in the upper urinary tract.
• Surgical resection is the treatment of choice, with minimally invasive options, such as transurethral resection of bladder tumor, being the preferred method.
• Conservative management, specifically surveillance, could be a valid option for a select group of asymptomatic patients with urinary tract leiomyoma.

     

Leiomyoma of the urinary bladder: report of three cases

We report 3 cases of leiomyoma of the urinary bladder. One patient was a 57-year-old female. Magnetic resonance imaging (MRI) revealed a small tumor, and cystoscopy revealed a submucosal tumor on the left wall. Partial cystectomy was performed, and she has had no recurrence for 10 months. Two females who were aged 68 years and 52 years, were referred to our hospital with the complaint of pain of meatus of urethra, and pollakisuria, respectively. Transurethral resection of bladder tumor (TURBT) was performed, and they have had no recurrence for more than 3 and 4 years, respectively. Histological examination in the three cases showed a leiomyoma of the urinary bladder. To our knowledge, there are 151 cases of leiomyoma of the urinary bladder reported in the literature in Japan.     

A case of leiomyoma of the urinary bladder in a woman with the chief complaint of total urinary retention

Benign nonepithelial tumor of the urinary bladder is very rare. We experienced a case of a 33-year-old woman who complained of total urinary retention. Vaginal examination revealed a hen's egg sized retrovesical tumor. IVP revealed a filling defect on the cystogram. Cystoscopy revealed protrusion of left side of the bladder neck and intact mucosa. Transvaginal needle biopsy of the tumor was done, and pathohistological diagnosis of the tumor was done, and pathohistological diagnosis of the specimen was leiomyoma. The tumor was intramural type and was resected. It was 5.5 X 5 X 5 cm in size, weighed 80 g, and pathohistological diagnosis was leiomyoma of the urinary bladder. 57 cases of leiomyoma of the urinary bladder including this case have been reported in Japan. No special method of diagnosing leiomyoma of the urinary bladder exists, but in some cases, needle biopsy is very effective.     

经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探

目的 探讨经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤的疗效及安全性。 方法 回顾性分析6例黏膜下型膀胱平滑肌瘤患者的临床资料。男2例,女4例。年龄32 ～ 78岁,平均59岁。表现为排尿梗阻3例,排尿刺激症状1例,肉眼血尿1例及无临床症状、体检发现1例。病程1周～4年,平均23个月。B超检查均发现膀胱内占位性病变,肿瘤平均最大直径3.0(2.0 ～3.5)cm。CT检查示肿瘤形态完整,增强后较均匀轻度强化。4例IVU检查发现膀胱充盈缺损。6例膀胱镜检查均提示膀胱黏膜下占位,黏膜表面光滑。6例均行膀胱镜下穿刺活检病理检查,诊断为膀胱平滑肌瘤,后行经尿道膀胱肿瘤剜除术（2例位于侧壁、体积较小肿瘤以激光剜除,4例体积较大肿瘤以电切镜剜除）。肿瘤基底部活检后,电灼肿瘤基底及创缘。 结果 6例手术均顺利完成,无膀胱穿孔等并发症。术后患者均排尿通畅,排尿刺激症状明显缓解,血尿消失。术后中位随访时间58(4～158)个月,未见肿瘤复发或转移。 结论 病理检查是确诊黏膜下型膀胱平滑肌瘤的主要手段。经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤安全有效。     

Male bladder leiomyoma: a case report]

A case of leiomyoma of the urinary bladder in a 40-year-old man is reported. Enucleation of the tumor was performed, because transurethral resection-biopsy revealed a bladder leiomyoma. Ninety nine cases of a bladder leiomyoma have been reported in Japan, but male cases are rare.     

Atypical leiomyoma of the urinary bladder--a rare tumor occurring in a young female with concurrent breast carcinoma--an influence of sex steroid hormone?

Smooth muscle tumors are uncommon in the urinary bladder, and atypical leiomyoma of the urinary bladder is extremely rare. We report a case of atypical leiomyoma with a concurrent breast carcinoma and discuss the pathologic features, the possible etiology and clinical outcome of the tumor.     

Leiomyoma of the urinary bladder treated by transurethral resection: a case report

A 59-year-old woman with complaints of pollakisuria and dysuria, was referred to our hospital. Magnetic resonance imageing (MRI) revealed a tumor, about 59 mm in diameter. Cystoscopy showed a submucosal tumor covered with a normal mucosa. Histological diagnosis was leiomyoma of the urinary bladder by transurethral biopsy. So we performed complete resection of the tumor. To our knowledge, 30 cases of leiomyoma of the urinary bladder by transurethral resection have been reported in the Japanese literature.     

A case of leiomyoma of urinary bladder with relapse from the external urethral orifice--clinical analysis of leiomyoma of urinary bladder in Japan

A 22-year-old female visited our hospital with complaints of pollakisuria and dysuria on July 3, 1987. Cystoscopy revealed a tumorous lesion in the urinary bladder. On July 8, 1987, she had urinary retention because of relapse of the tumor from the external urethral orifice. Under the diagnosis of urinary bladder tumor, tumorectomy was performed. The resected tumor had a steel, smooth surface, was elastic soft, red-purple and 7 g in weight. Pathological examination demonstrated the tumor to be composed of spindle-like cells, which showed no mitotic figures. Therefore, the tumor was diagnosed as leiomyoma of urinary bladder. In the literature, 67 cases of leiomyoma of the urinary bladder have been reported so far in Japan. The patients ages ranged from the 2nd to 8th decade, the peak age being the 4th decade. The sex ratio was 5 to 2, females being predominant. Chief complaints were hematuria, pollakisuria and dysuria, but prolapse of the tumor from the external urethral orifice was rare, only 3 cases including our case being reported thus far. Tumorectomy (34 cases, 27%) or partial cystectomy (16 cases, 27%) was performed in many cases, because it was benign. The prognosis was good, and there have been no reports stating that it become malignant.     

Leiomioma vesical

ObjectiveMesenchymal benign tumours of the urinary bladder are rare and account for 1%-5% of all bladder tumours. The leiomyoma is the most common and constitute 46.6% of this group. 25 cases have been described in the national literature. We report an additional case of leiomyoma of the bladderCase ReportA 53 year-old man with a chronic history of urinary frequency and microscopic hematuria. Physical examination was normal. An excretory urography demonstrated a filling defect in the right bladder wall. The cistoscopy confirmed the tumour, covered with normal bladder mucosa. The echography showed a solid tumour. A computerised tomography scan and magnetic resonance showed a sessile lesion in the right bladder wall with low-intermediate intensity signal and with normal signal of muscle, mucosa and perivesical fat. The clinical diagnosis was leiomyoma of the bladder. Partial cystectomy was done and the histological diagnosis confirmed the clinical diagnosisConclusionsThe leiomyoma of the bladder is a rare tumour however it should be considered in the differential diagnosis before surgical treatment     

Leiomyoma of the bladder causing bilateral hydronephrosis: a case report

We report a case of bladder leiomyoma with marked bilateral hydronephrosis caused by chronic urinary retention. Surgical finding was that the mass was smooth, fist-sized and had a thin stalk connected to the bladder wall. The tumor was completely removed. Histopathological diagnosis was leiomyoma of the bladder and the post-operative course was uneventful.     

A case of pure leiomyoma of the prostate]

Pure leiomyoma of the prostate is very rare. A 67-year-old man was hospitalized with gross hematuria and urinary retention. Drip infusion pyelography revealed a defect of the urinary bladder. By radiological examinations, submucosal tumor of the bladder neck was diagnosed. Transrectal biopsy suggested a benign prostatic tumor histologically. Open resection of the tumor was performed. Histological findings were pure leiomyoma of the prostate. The postoperative course was good and urinary retention was improved remarkably.     

Endometriosis of the Bladder as a Cause of Obstructive Uropathy

A 47-year-old woman (gravida 1, para 1) with menorrhagia and pelvic pain was found to have an enlarged fibroid uterus and bladder mass on ultrasonographic imaging. The patient underwent an abdominal supracervical hysterectomy and transurethral bladder mass resection. Histopathologic findings revealed leiomyoma uteri, intramural adenomyosis, and bladder endometriosis. Most case series of bladder endometriosis include women that present with urinary symptoms. This is a rare case of obstructive uropathy secondary to bladder endometriosis in a patient without any urinary signs or symptoms.     

Four cases of spontaneous rupture of the urinary bladder

Between November 1997 and March 2001, 4 female patients from 44 to 65 years of age with a spontaneous rupture of the urinary bladder were analyzed. They complained of abdominal pain and had undergone an intra-pelvic gynecological operation (3 for uterine cancer, 1 for an ovarian cyst) several years before. The three with uterine cancer had also received radiation therapy. For their present condition, spontaneous urinary bladder rupture, their treatment was indwelling a urethral catheter. Two of them have had no recurrence of urinary bladder rupture after one month since having the urethral catheter indwelt. One, however, had to have the catheter re-indwelt due to unsuccessful suturing of the urinary bladder wall. The fourth patient had bilateral nephrostomy tubes due to severe radiation cystitis. Thus, one can infer that intra-pelvic gynecological operations and radiation therapy are major factors causing spontaneous urinary bladder rupture. While indwelling a urethral catheter may be effective for some patients with a spontaneous rupture of the urinary bladder, it may be very difficult to treat more complicated cases.     

膀胱平滑肌瘤:附8例报告

目的 探讨膀胱平滑肌瘤的临床特点及诊治疗效.方法 对8例膀胱平滑肌瘤患者的临床资料进行回顾性分析.结果 8例患者,男性3例,女性5例,平均年龄42岁(27岁～71岁).经尿道膀胱肿瘤电切(TURBT)3例,开放膀胱部分切除术2例,肿瘤剜除2例,腹腔镜膀胱肿瘤剜除1例.8例患者随访10～75个月未见肿瘤复发.结论 膀胱平滑肌瘤临床罕见,手术效果满意,手术方式的选择应根据肿瘤大小和位置决定,腹腔镜手术创伤小、恢复快,将成为一种有效的手术替代方式.     

Acute urologic symptoms associated with uterine myoma

While prevalence of uterine leiomyoma is high, its presentation affecting the urinary tract is uncommon. We contribute the cases of two adult women with symptoms of nephritic colic and urinary retention. Etiology was acute obstruction of the urinary tract due to previously asymptomatic urine myomas. Management in both patients was surgery, using hysterectomy to resolve the urinary obstruction. A brief review of the literature is included.