Urinary retention and uterine leiomyomas: a case series and systematic review of the literature

Abstract

Uterine leiomyomas are underrecognized as a cause of acute urinary retention (AUR) in women. The objective of this study was to present a case series and systematic review of the literature, to elucidate the pathogenesis of leiomyoma-related AUR, and to suggest management strategies. We included patients presenting with AUR and uterine leiomyomas at our institution between January 2011 and December 2013. Further, we systematically searched the Cochrane Library (from 1898 to June 2014), EMBASE (from 1947 to June 2014), and MEDLINE (from 1946 to June 2014) databases according to the PRISMA guidelines. A total of six patients with AUR and leiomyomas presented to our institution. Through the systematic review, another 31 cases of AUR were identified. Combined patient ages ranged from 25 to 75 years. Uterine size ranged from 10 to 22 weeks on physical examination and from 5.5 to 26 cm on imaging. The dominant leiomyoma size ranged from 5.7 to 22.4 cm. Significant risk factors were posterior or fundal leiomyoma position and the presence of a retroverted uterus. Proposed mechanisms for leiomyoma-related AUR include proximal urethra or bladder-neck compression, premenstrual pelvic congestion, vascular steal effect, and compression of pudendal or sacral nerves. Patients were treated with hysterectomy, myomectomy, uterine fibroid embolization, hormones, or by conservative management alone. In the absence of neurologic disorders or other risk factors, neither urodynamic studies nor neuromuscular testing seem to contribute to diagnosis or guide management in women with uterine leiomyomas and AUR. Patients presenting to gynecologists seem to experience shorter times to diagnosis and treatment compared with other specialties. It is essential to recognize leiomyomas as a potential cause of AUR in order to reduce unnecessary testing and delays in diagnosis and management.

Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series

“…Uterine fibroids (myomas, leiomyomas) are an extremely rare cause of acute urinary retention with only a few case reports and series documented in literature [1][2][3][4]. Given the rarity of patient age (years) parity Symptoms Clinical findings investigations Surgery 1 42 3 Retention of urine -5 days, urination only on pressure; burning micturition; had surgical consultation before and was referred; cycles regular, normal flow.…”

“…A recent review of literature by Wu et al, revealed a total of 37 cases only in literature of uterine leiomyomas causing acute urinary retention (16 case reports and 5 case series); this included their own case series of 6 patients with acute urinary retention [1]. Various mechanisms have been postulated by which acute urinary retention may occur due to a leiomyoma.…”

“…A direct compression of only the lower portion of the bladder due to anterior and superior displacement of the cervix has also been postulated; a collapse of the lower bladder during supine position may lead to inadequate urine drainage into the urethra [1]. Other proposed mechanisms include pelvic congestion due to premenstrual hormonal induced factors [1], detrusor muscle ischemia due to vascular steal effect of the fibroid [15], and stretching of nerves that innervate the bladder, i.e., the pudendal and sacral nerves by the fibroid [16].…”

“…Other proposed mechanisms include pelvic congestion due to premenstrual hormonal induced factors [1], detrusor muscle ischemia due to vascular steal effect of the fibroid [15], and stretching of nerves that innervate the bladder, i.e., the pudendal and sacral nerves by the fibroid [16].…”

“…Rather than the actual size, impaction or incarceration of a leiomyoma or the uterus in the hollow of the sacrum may also be a critical factor for the development of acute urinary retention in the majority of cases [1]. This is borne out by the fact that very large uterine leiomyomas often do not cause acute retention of urine as they grow out of the sacral promontory freely without entrapment into the hollow of the sacrum [1].…”