Bladder Leiomyoma - An Unusual Cause of Acute Urinary Retention

Abstract

Introduction: Bladder leiomyomas are benign mesenchymal neoplasms with only 250 cases reported worldwide to date. They can be asymptomatic, but the majority present with obstructive symptoms (49%), irritative symptoms (38%) and hematuria (11%). The importance of recognizing their characteristic features, leading to their correct treatment, is fundamental. Methods:Case report and review of pertinent English medical literature.Results: A 53 year old lady presented with urgency and frequency for 3 months, with two episodes of painless total hematuria. She was catheterized for acute urinary retention elsewhere. Clinical examination was unremarkable. Ultrasound (US) showed a heterogeneously hypoechoic lesion of 4 x 3 cm in bladder base. Contrast enhanced computed tomogram (CECT) showed a 5 x 4 cm well circumscribed hypodense lesion arising from trigone, without hydroureteronephrosis. A mucosal bulge measuring around 5 x 5 cm was seen in the right lateral wall extending upto bladder neck at cystoscopy. Transurethral resection (TUR) was done and biopsy showed fragments of tumor tissue composed of spindle cells arranged in sheets and interlacing fascicles, without mitosis or necrosis, suggestive of leiomyoma bladder. Immunohistochemistry showed SMA and desmin positivity. Complete TUR enuceation was done and patient is doing well at 6 months of follow up without recurrence or hematuria. Conclusion:Leiomyoma of the bladder should be kept in mind in chronic lower urinary tract symptoms with acute urinary retention and hematuria in patients presenting in the third to sixth decade, especially in women. A complete assessment to look for endovesical leiomyoma should be made.