Diagnostic considerations in coexisting bladder and urethral leiomyomata. A case report

Leiomyomata of the lower urinary tract in women are rare. Coexisting urethral and bladder leiomyomata have never been reported before.

A 45-year-old woman, gravida 6, para 5, abortus 1, presented with a one-year history of increasing frequency, nocturia and hesitancy of up to 10-15 minutes at times. An intravenous pyelogram showed an extrinsic mass at the bladder neck. Urethrocystoscopy revealed a regular bulge at the level of the bladder neck on the right side without involvement of the bladder mucosa. Ultrasound showed a 5 x 4.7 x 4-cm mass of heterogeneous echogenicity, posterior to the bladder and anterior to the lower uterine area, with a normal-appearing uterus. The patient underwent surgery for vaginal excision of the tumor. Two separate masses were found at surgery. One small, firm, solid, 2-cm mass was found on the posterior proximal aspect of the urethra, and a larger, soft, 3 x 3-cm mass was found on the posterior lower aspect of the bladder. The masses clearly arose from the urethra and bladder, respectively. Rapid frozen section revealed smooth muscle cells consistent with leiomyomata. Both leiomyomata were entirely resected.

Lower urinary tract leiomyomata should always be considered in the differential diagnosis of an anterior vaginal mass in premenopausal women.