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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 142-144

Female anterior urethral wall leiomyoma: A rare presentation


1 Department of Urology and Kidney Transplantation, Narayana Medical College, Nellore, Andhra Pradesh, India
2 Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India

Date of Submission25-Apr-2021
Date of Decision05-Jul-2021
Date of Acceptance08-Jul-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Ifrah Ahmad Qazi
Department of Urology, Narayana Medical College, Nellore - 524 004, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_26_21

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  Abstract 


Leiomyomas are benign mesenchymal tumors commonly presenting as uterine masses. They are most frequently seen in females during the reproductive age. Extrauterine leiomyomas are rarely seen and primarily observed in the genitourinary tract. In general, patients come up with soft-tissue mass near the urethral meatus and urinary symptoms. We report a case of distal urethral leiomyoma in a 34-year-old woman who presented with periurethral mass with a history of hematuria and dysuria. She underwent complete excision of the mass. Due to their unusual location, these leiomyomas should be treated with great care during surgery. Postsurgery, the patient remained asymptomatic, and there was no evidence of recurrence in the follow-up.

Keywords: Distal urethral leiomyoma, leiomyoma, urethra


How to cite this article:
Reddy Pogula VM, Galeti EH, Qazi IA, Galeti A. Female anterior urethral wall leiomyoma: A rare presentation. J Curr Res Sci Med 2021;7:142-4

How to cite this URL:
Reddy Pogula VM, Galeti EH, Qazi IA, Galeti A. Female anterior urethral wall leiomyoma: A rare presentation. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jul 1];7:142-4. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/142/334452




  Introduction Top


Leiomyoma is a benign mesenchymal tumor that is rarely found in the urethra. It often appears in females during their reproductive age. The mean age of presentation is approximately 41 years. Buttner was the first person to report the first incidence of urethral leiomyoma.[1] Primary urethral leiomyoma is a rare clinical entity.[2] Most patients present with a mass protruding from the urethra and associated with an obstructive voiding pattern in a few cases. Prompt diagnosis, mainly the exclusion of a malignant tumor, and proper treatment are necessary to prevent complications. Herein, we report a case of female urethral leiomyoma, where the mass was located in the anterior wall of the distal urethra, which is usually not the site of presentation of leiomyoma in females.


  Case Report Top


A 34-year-old female patient presented with swelling in the external urethral orifice region, gradually increasing over the past 6 months. She had a history of hematuria and dysuria. She also complained of bleeding during intercourse. Physical examination revealed a firm and mobile, nontender tumor sized 3 cm × 2.5 cm located anteriorly, just proximal to the urethral meatus [Figure 1]. The urethral meatus was stretched and was situated at the bottom of the swelling and was not readily visible [Figure 2]. Ultrasound abdomen and pelvis revealed a normal study. Uroflowmetry was normal. Cystourethroscopy showed a tumor arising from the anterior wall of the urethra, extending 2 cm proximally from the meatus with congestion of the overlying mucosa. The remaining bladder and urethra were normal. Under spinal anesthesia and lithotomy position, after putting the stay sutures on the urethra, a circumferential incision was given at the tumor base. The tumor was completely excised, and mucosal edges were sutured. The urethra was calibrated with a 16-French Foley catheter [Figure 3], and an indwelling Foley catheter was kept inserted for 7 days. She was discharged on the first postoperative day. The patient voided normally after Foley catheter removal. Histopathology revealed an encapsulated tumor containing spindle cells with elongated bland nuclei with a dense collection of mixed inflammatory cells, suggesting a benign leiomyoma [Figure 4]. The patient was followed up for 6 months. The patient remained asymptomatic with no recurrence.
Figure 1: Tumor of size 3 cm × 2.5 cm located anterior and proximal to the urethral meatus

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Figure 2: Urethral meatus stretched and located at the bottom of the swelling

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Figure 3: Posttumor excision photo of the urethral meatus with 16-French Foley catheter in situ

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Figure 4: Histopathological examination showing benign spindle cell lesion suggestive of leiomyoma

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  Discussion Top


Urethral tumors are rare and arise from the glandular epithelium or the smooth muscle fibers. Polyps and papillomas are the most common, and leiomyomas are the least common clinical entities.[3] Primary urethral leiomyoma is seen more commonly in females than in males, and it usually develops from the posterior wall of the proximal urethra.[4] In our case, the mass was located at the anterior wall of the distal urethra with voiding problems. The most common symptom found in most cases is swelling near the periurethral region. Other symptoms include hematuria, dysuria, repeated urinary tract infection, and dyspareunia. It has been noted that some tumors enlarge during pregnancy and shrink after delivery, suggesting an underlying hormonal etiology.[5] In a few cases, estrogen and progesterone receptors have also been identified in leiomyoma. Our case was a fertile woman, which may support the hormonal origin of smooth muscle hyperplasia in the development of leiomyomas. Differential diagnosis mainly includes urethral mucosal prolapse, urethral caruncle, urethral diverticulum, Bartholin's gland cyst, Gartner's duct cyst, and urethral carcinoma. Clinical examination, cystourethroscopy, and imaging studies such as vaginal ultrasonography and pelvic magnetic resonance imaging help establish a definitive diagnosis.[6] However, the histopathological examination can distinguish a leiomyoma from a malignant tumor. Simple surgical excision is the treatment of choice.[7] During surgical excision, care needs to be taken not to damage the urethra. An indwelling Foley catheter should be left in place for an extended time to prevent complications such as stenosis or fistula. Other treatment options include transurethral resection and gonadotropin-releasing hormone therapy,[8],[9] but these have not been well established as yet. The prognosis is good as there are no malignant transformation reports and tumor recurrence.[10]


  Conclusion Top


Leiomyoma is a benign mesenchymal tumor that is rarely found in the urethra. The position of leiomyoma, in this case, makes it an interesting one where the mass was located in the anterior aspect of the distal urethra, which is an unusual site of presentation. A careful clinical examination and cystourethroscopy help establish a diagnosis. The treatment of choice is a simple surgical resection. However, a histopathological examination is mandatory to distinguish a leiomyoma from a malignant tumor.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Buttner C. A case of myoma of the female urethra. Z Geburshc Gynak 1894;28:135-6.  Back to cited text no. 1
    
2.
Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR, et al. Current medical treatment of uterine fibroids. Obstet Gynecol Sci 2018;61:192-201.  Back to cited text no. 2
    
3.
Shield DE, Weiss RM. Leiomyoma of the female urethra. J Urol 1973;109:430-1.  Back to cited text no. 3
    
4.
Beng Kwang N, Naidu A, Yahaya A, Pei Shan L. Urethral leiomyoma: A rare clinical entity. Case Rep Surg 2016;2016:6037104.  Back to cited text no. 4
    
5.
Fry M, Wheeler JS Jr., Mata JA, Culkin DJ, St Martin E, Venable DD. Leiomyoma of the female urethra. J Urol 1988;140:613-4.  Back to cited text no. 5
    
6.
Dmochowski RR, Ganabathi K, Zimmern PE, Leach GE. Benign female periurethral masses. J Urol 1994;152:1943-51.  Back to cited text no. 6
    
7.
Deka PM, Rajeev TP. Leiomyoma of the female urethra. Urol Int 2003;71:224-5.  Back to cited text no. 7
    
8.
Joshi HB, Beck RO. Leiomyoma of the female urethra with upper tract dilation and treatment with transurethral resection: A case report and literature review. Tech Urol 2000;6:223-5.  Back to cited text no. 8
    
9.
Goldman HB, McAchran SE, MacLennan GT. Leiomyoma of the urethra and bladder. J Urol 2007;177:1890.  Back to cited text no. 9
    
10.
Merrell RW, Brown HE. Recurrent urethral leiomyoma presenting as stress incontinence. Urology 1981;17:588-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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