Fibroid-induced acute urinary retention: treatment by uterine artery embolization

A 39-year-old gravida 2 para 2 woman presented to our Hospital's Emergency Department with complaints of difficulty voiding. She had an enlarged leiomyomatous uterus, for which she was not receiving any current treatment. A Foley catheter placed yielded 1,500 cc of clear yellow urine; however, the patient remained Foley-dependent for 2 weeks until she underwent uterine artery embolization (UAE). Twenty-four hours afterwards, the Foley catheter was removed and the patient spontaneously voided with negligible post-void residual. There was no recurrence of urinary retention or development of any other urinary symptoms during the outpatient follow-up period. Repeat pelvic magnetic resonance imaging (MRI) 1 week after UAE showed negligible reduction in the size of the fibroids and uterus in comparison with a pre-procedure MRI. The Vascular Steal Theory, first presented in this paper, discusses this improvement in symptoms without significant change in size.