Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound

Area of Science:

• Urogynecology
• Medical Imaging
• Diagnostic Ultrasound

Background:

• A 73-year-old female presented with a 3-year history of overactive bladder and voiding dysfunction.
• Clinical gynecological examination and routine 2D perineal ultrasound revealed no pelvic organ prolapse or abnormalities, but significant residual urine and limited bladder neck mobility.

Purpose of the Study:

• To evaluate the efficacy of 3D perineal ultrasound in detecting an unusual subpubic tumor.
• To compare the diagnostic capabilities of 3D perineal ultrasound with clinical examination and 2D perineal ultrasound.

Main Methods:

• Standardized 3D perineal ultrasound was employed for imaging.
• Surgical excision of the detected tumor via a vaginal incision.
• Postoperative management included a suburethral sling for de novo stress urinary incontinence.

Main Results:

• 3D perineal ultrasound identified a 24 × 26 × 32 mm hypoechoic subpubic tumor missed by prior assessments.
• The tumor was successfully excised, and the patient recovered well.
• Post-surgical urinary incontinence was successfully treated, restoring continence and resolving voiding dysfunction.

Conclusions:

• 3D perineal ultrasound is superior to clinical examination and 2D ultrasound for detecting unusual subpubic tumors.
• This advanced imaging modality is a valuable tool in the diagnostic workup for bladder outlet obstruction.
• 3D perineal ultrasound enhances diagnostic accuracy and contributes to improved patient management in urogynecology.