LEIOMYOMA OF THE FEMALE URETHRA AND BLADDER - REPORT OF 23 PATIENTS AND REVIEW OF THE LITERATURE

OBJECTIVES: Our purpose was to review what may be the largest experien ce of bladder and urethral leiomyomas from a single institution. STUDY DESIGN: A retrospective review was done of 23 female patients with em phasis on presentation, symptoms, and operative approach for excision. RESULTS: The majority of bladder and urethral leiomyomas in this seri es were asymptomatic, nonobstructive, or incidental (discovered at sur gery for another entity). Ten patients had a palpable mass on physical examination. Two patients had pain as a presenting complaint. The rou te of operative excision was transvaginal (10 patients), transurethral (6 patients), or abdominal (6 patients). One patient had the leiomyom a removed elsewhere with a resultant vesicovaginal fistula. CONCLUSION S: Corollaries should be sought with the experience of uterine leiomyo mas, which are histologically identical to bladder leiomyomas. Asympto matic, nonobstructive, and nonproblematic leiomyomas should not serve as an indication for primary operation. Pedunculated endovesical lesio ns may be an exception because of the ease of transurethral removal an d their tendency to cause future symptoms. Ultrasonographic imaging, c ystoscopy, and biopsy should be considered to allow observation and fo llow-up of leiomyomas. Future investigative cytogenetic studies should be considered on these mesenchymal tumors.