DIAGNOSTIC CONSIDERATIONS IN COEXISTING BLADDER AND URETHRAL LEIOMYOMATA - A CASE-REPORT

BACKGROUND: Leiomyomata of the lower urinary tract in women are rare. Coexisting urethral and bladder leiomyomata have never been reported b efore. CASE: A 45-year-old woman, gravida 6, para 5, abortus 1, presen ted with a one-year history of increasing frequency, nocturia and hesi tancy of up to 10-15 minutes at times. An intravenous pyelogram showed an extrinsic mass at the bladder neck. Urethrocystoscopy revealed a r egular bulge at the level of the bladder neck on the right side withou t involvement of the bladder mucosa. Ultrasound showed a 5 x 4.7 x 4-c m mass of heterogeneous ecchogenicity, posterior to the bladder and an terior to the lower uterine area, with a normal-appearing uterus. The patient underwent surgery for vaginal excision of the tumor. Two separ ate masses were found at surgery. One small, firm, solid, 2-cm mass wa s 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 bl adder, respectively. Rapid frozen section revealed smooth muscle cells consistent with leiomyomata. Both leiomyomata were entirely resected. CONCLUSION: Lower urinary tract leiomyomata should always be consider ed in the differential diagnosis of an anterior vaginal mass in premen opausal women.