Leiomioma en uretra femenina. Reporte de un caso / Female urethral leiomyoma. A case report

Resumen ANTECEDENTES: los leiomiomas son tumores benignos de origen mesenquimatoso que afectan el músculo liso; sin embargo, se han reportado casos excepcionales en el aparato urinario (riñón, vejiga o uretra). CASO CLÍNICO: paciente de 45 años de edad, con incontinencia urinaria de esfuerzo y de urgencia de dos años de evolución, y sensación de cuerpo extraño en la vulva. A la exploración física se encontró, en la especuloscopia: Valsalva (+) y salida de orina por el meato uretral; se identificó una tumoración en la región parauretral derecha, de consistencia firme, móvil, que se desplazaba hacia la uretra de manera contralateral (uretra permeable). Se utilizó la clasificación POP-Q para evaluar el prolapso de la pared anterior de la vagina, con resultado: IV Aa (+4). El tratamiento consistió en escisión vaginal, cuyos hallazgos macroscópicos fueron: tumoración redondeada de bordes regulares, de consistencia sólida, sumamente vascularizada, de 7 x 5 cm. El reporte de histopatología fue leiomioma de uretra sin evidencia de malignidad. El estudio de inmunohistoquímica demostró positividad para actina de músculo liso en las células fusiformes de fascículos proliferantes. CONCLUSIONES: el leiomioma en la uretra femenina es una neoplasia excepcional. El tratamiento de elección consiste en escisión transvaginal y el diagnóstico definitivo se establece mediante estudios de histopatología e inmunohistoquímica.

Abstract BACKGROUND: Leiomyomas are benign neoplasms of mesenchymal origin in muscle, very rarely can be found in any area of the urinary tract, such as kidney, bladder and rarely urethra. OBJECTIVE: Report of a case of gynecological patient with urethral leiomyoma. CASE REPORT: A 45-year-old female patient who presented with urinary leakage of two years of effort and with urgency, sensation of a foreign body in a vulvar region. Physical examination: speculum: Valsalva (+), urine output by urethral meatus; a tumor is defined as a right paraurethral region with a firm, mobile consistency that displaces the contralateral urethra, permeable urethra, POP-Q is performed by anterior wall prolapse of the vagina: IV Aa (+4). Treatment consisted of vaginal excision, finding rounded tumor of regular borders, solid consistency, very vascularized of 7 x 5 cm approximately. The histopathology result was a urethral leiomyoma with no evidence of malignancy. Positive immunohistochemical staining for smooth muscle actin was reported in spindle cells with proliferative fascicles. CONCLUSIONS: Female urethral leiomyoma is a rare entity, its treatment of choice is transvaginal excision and its diagnosis is made through histopathology supported by immunohistochemistry. It is important to carry out a complete study protocol taking into account in the differential diagnosis malignant neoplasms.

Cálculo gigante enclavado en meato uretral femenino: resolución en área de urgencias / Giant calculus located in the female urethral meatus: resolution in an emergency setting

Objetivo: Comunicar un caso inusual de cálculo uretral femenino gigante enclavado en meato, que debutó por sangrado genital, sin retención urinaria ni síntomas miccionales. El cálculo era visible en el introito. Se efectuó tratamiento resolutivo en el área de urgencias, cursándose el alta a las pocas horas. Métodos: Se presenta el caso de una paciente de 82 años, con antecedentes remotos de cirugía vesical, que acudió a urgencias por sangrado genital. Valorada por Ginecología se apreció un gran cálculo uretral que a¬ oraba por el meato, derivándose a Urología. Tras la exploración física se solicitó radiografía simple de pelvis donde se apreció un gran calculo uretral de 6 x 4 cm. Bajo anestesia local se practicó meatotomía inferior con luxación y extracción del cálculo; siendo dada de alta a continuación con sonda vesical hasta la cicatrización de la herida. Resultados: La evolución tras el “parto del cálculo” fue favorable. Se cursó el alta con sonda vesical a las pocas horas de la extracción litiásica. Acudió nuevamente a urgencias 12 horas más tarde por arrancamiento involuntario de la sonda, siendo nuevamente sondada y dada de alta. La evolución posterior fue favorable, retirándose la sonda y conservando la micción espontanea. Conclusiones: El síntoma de sangrado genital femenino, no siempre se corresponde con problemas ginecológicos. La patología de la uretra femenina también puede ser su responsable: carúnculas, prolapsos, divertículos, quistes parauretrales de Skene, estenosis o cálculos como el caso presentado. Casos como éste pueden ser resueltos en la propia área de urgencias con relativa facilidad y sin necesidad de ingreso hospitalario.

Objective: To communicate the unusual case of a giant female urethral calculus located in the meatus, which presented with genital bleeding, without urinary retention or voiding symptoms. The calculus was visible at the introitus. Resolving treatment was performed in the emergency setting, progressing to discharge in a few hours. Methods: The case involved an 82–year-old patient with a remote history of bladder surgery who came to the emergency room with genital bleeding. On evaluation by the Gynecology staff, a large urethral calculus was found in the meatus, and a referral was made to the Urology department. After a physical examination, simple radiographs of the pelvis were ordered, in which a large urethral calculus (6 × 4 cm) was identified. Under local anesthesia, an inferior meatotomy was performed with luxation and extraction of the calculus; the patient was discharged with a catheter that was left in place until the wound healed. Results: The evolution after the “birth” of the calculus was favorable. The patient was discharged with a catheter a few hours after extraction of the lith. She returned to the emergency setting 12 hours later after inadvertently pulling out the catheter and was recatheterized and discharged. The patient’s later evolution was favorable; after removing the catheter, she maintained spontaneous voiding. Conclusions: The symptom of female genital bleeding does not always correspond to gynecological problems. Female urethral pathology can also be responsible; caruncles, prolapses, diverticuli, paraurethral cysts of the Skene’s gland, stenosis, or calculi, as in the case presented, can all result in bleeding. Cases like this one can be resolved in the emergency department relatively simply and without necessitating an inpatient admission.

Calculi In A Female Urethral: A Rare Cause of Acute Urinary Retention.

Urinary calculi are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. The case of a 23-year-old woman presented with acute retention of urine associated with recurrent urinary tract infection. Cystoscopy was done and the stone was removed. The patient has been well, with no dysuria, and incontinence for 3-month follow-ups.

A Case of Leiomyoma in the Female Urethra

Leiomyoma of the female urethra is exceedingly rare entity. Twenty-four year woman admitted to the hospital with a painless, gross hematuria and protruded mass outside the vaginal introitus. Vaginal examination revealed a mass arising from anterior urethral wall extending from meatus up to 1 cm proximally. Histopathological studies confirmed urethral leiomyoma. Surgery completely resolved the original symptoms and no evidence of complications after surgery. We report a case of leiomyoma of the female urethra and a review of the literature.

A Case of Leiomyoma of Female Urethra

Leiomyoma of the female urethra is a rare entity. We experienced a case of leiomyoma in the female urethra recently. Forty-one-year-old woman admitted to the hospital with the chief complaint of a painless, protruded large mass outside the vaginal introitus. The mass was excised surgically and confirmed as a leiomyoma pathologically.

The Clinical Experience of Leiomyoma of the Female Urethra / 대한비뇨기과학회지

PURPOSE: Leiomyoma of the urethra is a rare disease entity. We treated leiomyoma of the female urethra surgically during the period from 1981 to 1997 and retrospectively reviewed the results. MATERIALS AND METHODS: We have experienced 11 cases of the leiomyoma of the female urethra. History taking, clinical symptoms, urinalysis, laboratory findings, cystoscopic finding, postoperative complication and follow-up examination were observed retrospectively. Also, we checked pelvic computed tomography in 2 cases which had been detected uterine mass at pelvic ultrasonography. RESULTS: Average age of the patients was 40 years (28-51) and the chief complaint was a painless mass of anterior vaginal wall. All masses were removed surgically and confirmed as leiomyoma histologically. The uterine leiomyoma was combined in 2 cases. There were no recurrence or complication after surgery until now. CONCLUSIONS: A surgical removal of the leiomyoma of the female urethra provided a long term disease free survival and the search for the associated pelvic leiomyoma should be done.

A Case of Complete Female Urethral Loss with Vesicovaginal Fistula / 대한비뇨기과학회지

Complete urethral loss with vesicovaginal fistula is very infrequently encountered by the urologist. Urethral reconstruction may be accomplished with either bladder or vaginal wall flap. Moreover, it usually is necessary to reinforce the continence of reconstructed urethra with a well-vascularized pedicle flap from either the Martius labial flap, gracilis, perineum, or rectus. We report a case of the complete urethral loss with vesicovaginal fistula treated successfully with bilateral Martius labial fat graft.

A Case of Transitional Cell Carcinoma of the Female Distal Urethra / 대한비뇨기과학회지

Primary carcinoma of the female urethra is relatively rare neoplasm. Urethral cancers account for less than 0.02 per cent of all neoplasms occurring In women and 0.01 per cent of all urologic malignancies. The rarity of the disease as well as the changes and improvements in the various treatment modalities have prevented unanimity of opinion with regard to its proper treatment. We report one case of transitional cell carcinoma in female urethra with brief review of the literature.

Complete Traumatic Rupture of Female Urethra

Four cases of complete traumatic rupture of female urethra were reviewed. Herein the incidence, etiology and treatment modalities of complete rupture of female urethra are discussed to propose guidelines for the proper management of these unusual injuries. I recommend the following: Through the retropubic approach in children, a primary realignment with either surgery or an interlocking Foley catheterization should be performed as in the delayed retropubic urethroplasty when primary realignment was not accomplished. Transvaginal repair is considered choice approach for the urethro-vaginal laceration due to other than pelvic fracture in adults.

A Case of Leiomyoma in the Female Urethra / 대한비뇨기과학회지

Leiomyoma of the female urethra is a very rare entity. A case of leiomyoma of the female urethra in a 47year-old female, who had presenting symptoms with a protruded large mass outside the vaginal introitus, was presented. The mass was enucleated surgically and confirmed as a leiomyoma pathologically.

A Case of Polyp in the Female Urethra / 대한비뇨기과학회지

True polyps of the urethra are extremely rare. We experienced a case of polyp in the female urethra recently 22-year-old female patient was admitted to the Department of Urology of kyung Hee University Hospital due to a protruding mass through the external urethral meatus. The mass was removed by electroresection and confirmed as a true polyp pathologically. It was a ovoid soft mass. 1.2 x 0.5 x 0.4 cm in size, well encapsulated by hypertrophied epithelium and it was composed of fibrous tissue.

A Case of Fibroma in the Female Urethra / 대한비뇨기과학회지

Fibromas of the urethra are extremely rare. We experienced a case of fibroma in the female urethra recently. 48-year-old female patient was admitted to the Department of Urology of Seoul National University Hospital due to a protruded mass on external urethral meatus. The mass was removed surgically and confirmed as a fibroma pathologically. It was a huge mass, 17 X 9 X 7 cm in size, irregularly lobulated, firm and well encapsulated. Histologically it was composed of loosely textiled spindle cells of fibroblastic origin with myxoid changes.