Leiomyoma in the Retzius space: a rare cause for voiding difficulties

Abstract

A 54-year-old woman with voiding difficulties was referred to our department. She complained about a slow urine stream, hesitancy, straining when voiding and the feeling of incomplete emptying. The gynaecological examination revealed a 4x3 cm pelvic tumour. The tumour was well circumscribed in the retropubic space between the symphysis and the bladder neck sonographically and by magnetic resonance imaging and was closed off from neighbouring structures. After removal of the tumour, the voiding problems were reversed, and the patient has remained asymptomatic. The histological examination showed a leiomyoma with high vascularisation. This case report showed that retropubic tumours can obstruct the urethra and cause voiding dysfunctions. Consequently, this needs to be considered in the differential diagnosis.

The relationship between uterine leiomyomata and pelvic floor symptoms

“…Case reports have described uterine leiomyomata causing urinary retention and/or hydronephrosis [10][11][12]. It is proposed that large leiomyomata might cause urinary frequency, urinary urgency, constipation or tenesmus via mass effect on the bladder and rectosigmoid [8,13,14] and anterior leiomyomata appear to be more associated with lower urinary tract symptoms than leiomyomata in other locations [15].…”

Leiomyoma in Retzius’ space: An unusual location

“…3 Leiomyomas in Retzius' space are extremely rare, and only 3 cases have been reported (Table 1). 4,5 The differential diagnosis of tumours in Retzius' space includes true tumours and tumour-like lesions, such as a hematoma 6 or an abscess. 7 Although the most important differential diagnosis of retroperitoneal leiomyoma includes leiomyosarcoma, there are no reports of leiomyosarcoma in Retzius' space.…”

“…True tumours in Retzius' space are extremely rare, and very few cases, including 3 cases of leiomyoma, have been reported. 4,5,[8][9][10] A clinical challenge in the management of retroperitoneal leiomyoma is the accuracy with which it can be dif-…”

Columnar cystic metaplasia in Retzius’ space

“…It is more frequently the site of metastatic lesions or lymphoma, and primary tumors are very rare in this location. More common primary tumors described in Retzius' space are leiomyoma [1] that can produce voiding problems depending on size, rhabdomyosarcoma [2] that principally occur in the pediatric age group, and cystic lymphangioma [3] that can present as acute abdomen.…”

“…Benign tumors in Retzius' space are generally leiomyomas, and although there are individual case reports in the literature of other tumors [1], columnar cystic metaplasia in Retzius' space has not previously been described. An abdominalpelvic CT scan is important to determine the tumor size and extension to other organs such as the bladder, uterus and vagina.…”