Vaginal Myomectomy to Resolve Bladder Outlet Obstruction 50 Years After Hysterectomy

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Abstract

Background

Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence.

Case

Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence.

Conclusion

Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.

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