Dual treatment approach for leiomyomas of urinary bladder: Experience from tertiary hospital.

INTRODUCTION AND IMPORTANCE

Leiomyomas are rare, benign mesenchymal tumors. They represent 1 to 5 % of all urinary bladder tumors. 20 % are asymptomatic, but most presentations are voiding and storage, followed by hematuria. Surgery has been reported to be a standard treatment, depending on the size of the tumor and its location in the bladder. The following case report, we discuss the case of a bladder leiomyoma presenting with storage and voiding symptoms and managed with dual approach of Transurethral resection of bladder tumor (TURBT) and open urethrotomy.

CASE PRESENTATION

A 39-year-old female who presented with a one-year history of total hematuria and a blood clot that was ovoid in shape presented with urge incontinence, nocturia, strain during urination, and incomplete bladder emptying. She was mildly anemic, afebrile, with no palpable peripheral lymph node and no palpable mass. PVE revealed an anteriorly located cervix. The patient's Labs revealed to have moderate anemia of 8 g/dl, blood chemistry was uneventful, and ultrasound (USS) revealed that both kidneys were normal. The urinary bladder was well distended, with a mass located at the base, measuring 4.13 cm × 4.14 cm. MRI revealed a well-circumscribed intramural tumor on the left side measuring 4.3 cm × 4.2 cm, close to the bladder neck. A cystoscopy was used to visualize the tumor from the left lateral wall at 3 o'clock, extending to 5 o'clock, and part of the bladder neck. The tumor was solid, easily bled, and had an irregular margin, and the bladder mucosa was normal. The 1st TURBT was used for diagnosis; although she still persistent storage and voiding symptoms, she subsequently underwent 2nd TURBT, which was resected to completion with the aid of ventral urethrotomy. After the TURBT, tumor protruded into the urethra, complete excision was performed through the urethra due to extension of the tumor to the urethra. The patient's postoperative events were uneventful, and the patient was discharged with catheter care for 10 days. On follow-up, hematuria resolved, and there were no lower urinary tract symptoms.

CLINICAL DISCUSSION

Leiomyoma of the urinary bladder is a rare, benign mesenchymal tumor. They are the most common type of tumor of the urinary bladder. The most common presentations are storage and voiding symptoms, and hematuria. The initial USS can be used, and CT IVU or MRI is necessary for surveillance of the upper tract, possibly with respect to the tumor location in relation to the ureteric orifice. Tumors can be endovesical, intramural or extravesical, resulting in different presentations. Some tumors are pedunculated and can move close to the bladder neck or even at the urethra and present with urinary retention. Leiomyomas are surgically excised, and sometimes via a dual approach, transurethral resection of bladder tumors is important. These patients have a very low recurrence rate and are symptom free, and they have a good prognosis.

CONCLUSION

Leiomyomas are surgically excised, and sometimes via a dual approach, transurethral resection of bladder tumors is important. These patients have a very low recurrence rate and are symptom free, and they have a good prognosis.