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

Unusual case of a leiomyoma in the space of Retzius mimicking broad ligament fibroid

This case report will discuss an interesting case of a patient who presented with pain in the lower abdomen of 2-month duration. Clinical examination and imaging findings were suggestive of a broad ligament fibroid. However, intraoperatively, the mass was found to be present in the space of Retzius, which is an extremely rare location for such a pathology. The access to the tumour was very challenging. Successful surgical excision was done with the help of a multidisciplinary team involving a gynaecologist, a urologist and an anaesthetist. Histopathology reported it to be benign leiomyoma. Postoperatively, the patient made an uneventful recovery.

Leiomyoma of the Retzius space in a male patient: A case report and a diagnostic approach to Retzius space diseases

Retzius space is a small anatomical compartment located directly posterior to the pubic symphysis and anterior to the urinary bladder. Diseases developing primarily in this space are rare; only 7 cases of leiomyomas of the Retzius space have been reported in the literature so far, all of them in female patients. We present a unique case of a leiomyoma of the Retzius space in a male patient. An imaging-based diagnostic approach to Retzius space disease is proposed.

Leiomyoma in the Retzius space

Parauterine location of leiomyomas is observed to be an extremely rare clinical condition. However, when benign or malignant primary tumours are detected in that area, they are often found in the Retzius space. There have been only six cases of leiomyomas in the Retzius space reported in the literature so far. The paper presents one such leiomyoma case located in the Retzius space. This extremely rare location of the tumour justifies its presentation. The medical records of the patient treated in the outpatient’s obstetrics and gynaecology (ob-gyn) clinic, her case history, and hospital records, supplemented by information obtained from the patient’s daughter, were analysed. The patient, a 50-year-old woman with type 2 diabetes, was referred to hospital for diagnosed secondary anaemia due to heavy menstruation for four months, which was associated with intramural leiomyoma in the anterior wall of the uterine body. Clinical examination found a large leiomyoma located in the anterior wall of the uterus. Laparotomy was performed: apart from and a leiomyoma in the uterine body it found a tumour, 140 × 100 mm in size, in the Retzius space. Total resection of the tumour was performed. Since the leiomyoma was located in the uterine wall, hysterectomy with bilateral excision of adnexa was also performed. The patient was discharged home in generally good condition on the sixth day following the operation. Concomitant occurrence of leiomyoma atypically located in the Retzius space and leiomyoma in the uterine body made perioperative diagnosis very difficult.

The relationship between uterine leiomyomata and pelvic floor symptoms

INTRODUCTION AND HYPOTHESIS

To compare pelvic floor symptoms in women with a leiomyomatous uterus ≤12 weeks and those >12 weeks in size and to evaluate the resolution of these symptoms after surgical intervention.

METHODS

The PFDI-20, PFIQ-7 and 3-day voiding diaries were administered prospectively to all subjects. Demographics and questionnaire responses were compared using a t test, Chi-squared test or Mann-Whitney U test as indicated.

RESULTS

One hundred and forty-five women completed the questionnaires and were included for analysis. There were 58 women with uterine size ≤12 weeks (group I) and 87 women with size >12 weeks (group II). Participants in group I reported more straining to defecate (p = 0.042), while group II reported increased feeling of incomplete bladder emptying (p = 0.007) and difficulty emptying their bladder (p = 0.008). Review of ultrasound images revealed no difference in pelvic floor symptoms when stratified by leiomyoma location. At 1-year follow-up, 69 women (48 %) responded, and 40 (58 %) had undergone surgical intervention. Surgery was shown to improve symptoms for all questions reviewed at 1-year follow-up.

CONCLUSIONS

A leiomyomatous uterus >12 weeks is associated with the symptom of incomplete bladder emptying, but does not appear to have an effect on other pelvic floor symptoms compared with women with a smaller leiomyomatous uterus. Surgical intervention for leiomyomata improves pelvic floor symptoms.

Giant leiomyoma of the retzius space: a case report

Extrauterine leiomyoma is a very rare clinical condition; we report a case of leiomyoma of the Retzius space in a 49-year-old women who suffered for two years from bladder voiding symptoms characterized by dysuria, feeling of incomplete emptying, and pelvic pain. Clinical evaluation and abdominal and transvaginal ultrasound suggested the presence of a voluminous (about 10 cm in diameter) fibromyoma of the anterior uterus surface. The urodynamic evaluation demonstrated the presence of bladder outlet obstruction (voiding pressure greater than 20 cm H2O and maximum flow rate less than 12 mL/s) with a postvoiding urine residual equal to 80 mL; moreover, the presence of cystocele and urethral stricture was ruled out performing clinical evaluation, cystography, and cystourethroscopy. The patient underwent laparotomy to remove the uterine fibromyoma. Intraoperatively, a voluminous soft mass arising from the Retzius space was found; it was firmly adhered to the uterus with obliteration of vesicouterine pouch owing to severe adhesion to the anterior surface of uterus. The tumour was isolated, enucleated from the prevesical space, and removed; moreover, the patient became asymptomatic after surgery. In conclusion, leiomyoma of the Retzius space is a very rare benign tumour that should be considered in the presence of severe bladder voiding symptoms.

A new era for treating vaginal aplasia using transretropubic balloon vaginoplasty approach

OBJECTIVE

To test the efficacy, safety, and tolerability of a novel surgical alternative for formation of a neovagina in patients with vaginal aplasia.

DESIGN

Technique and instrumentations.

SETTING

A specialized endoscopic surgery center.

PATIENT(S)

Four patients with complete vaginal aplasia, three of them without a uterus and one with a functioning uterus.

INTERVENTION(S)

A silicone Foley catheter sutured to the distal end of a sharp curved needle with a wide eye attached to a plastic handle and passed extraperitoneally into the space of Retzius followed by its inflation and upward traction for 8 days. Clinical and magnetic resonance imaging (MRI) follow-up were done.

MAIN OUTCOME MEASURE(S)

Operative time, complication rate, tolerability of traction and retraction, reintervention rate, width and length of the newly formed vagina, and postoperative feasibility of intravaginal sexual intercourse for married cases.

RESULT(S)

The results were satisfactory (normal length and width of neovagina), without complications and with acceptable tolerability and normal sexual life within 8-10 days postoperatively for the married women.

CONCLUSION(S)

Both clinical and MRI follow-up confirmed that retropubic balloon vaginoplasty is a simple, fast, tolerable, safe, and available extraperitoneal procedure. It can be easily done by any gynecologist having basic knowledge of the anatomy of the retropubic space.

Female voiding dysfunction: prevalence and common associations

The understanding of voiding dysfunction has been greatly assisted by the current introduction of clear definitions for its diagnosis and for the abnormalities of urine flow rates and postvoid residuals that are its basis. Its prevalence in women with symptoms of pelvic floor dysfunction is up to 40%. Most of the recent research has centered on the associations of voiding dysfunction with age, pelvic organ prolapse, and prior continence surgery. The effects of parity, medications, and pelvic tumors have also been explored.