Transvesical laparoscopy for bladder leiomyoma excision: a novel surgical technique
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IUJ VIDEO
Transvesical laparoscopy for bladder leiomyoma excision: a novel surgical technique Guido M. Rey Valzacchi 1 Jose M. Saadi 1
&
Lucila I. Pavan 1 & Geronimo A. Bourguignon 1 & Juan P. Cortez 1 & Enrique P. Ubertazzi 1 &
Received: 6 June 2020 / Accepted: 2 October 2020 # The International Urogynecological Association 2020
Abstract Introductionand hypothesis Leiomyomas of the urinary bladder are rare tumors. Submucosal leiomyomas, when small and easily accessible, can be treated with transurethral resection, while unfavorably positioned or larger leiomyomas may be treated through an abdominal approach. In these cases, a laparoscopic approach for intravesical surgery is an alternative that may be considered. We aim to demonstrate a novel transvesical laparoscopic approach to bladder leiomyoma excision with a video. Methods A 45-year-old woman with urinary symptoms and a 40-mm submucosal bladder leiomyoma located at the interureteric ridge was referred to our hospital (tertiary referral hospital). Due to the location and size of the leiomyoma, and to increase the probability of complete resection, a transvesical laparoscopic approach was decided. A step-by-step video is presented to describe the surgical technique. Results There were no intra- or postoperative complications. The patient was discharged 48 h after the surgery. At 60 months’ follow-up, the patient remains asymptomatic. Conclusions Transvesical laparoscopy may be considered for excision of bladder leiomyomas. This approach is feasible for trained surgeons as it requires a small working space. Keywords Laparoscopic surgery . Myoma . Pneumovesicum
Aim of the video/introduction Leiomyomas of the urinary bladder are rare benign mesenchymal neoplasms with an incidence of < 0.5% of all the bladder tumors. The etiology is still unknown. They arise in the submucosa, but can be submucosal, intramural, or extravesical. Submucosal, i.e., endovesical, is the most common location, and it corresponds to 63–86% of cases, while intramural and extravesical leiomyomas correspond to 3–7% and 11–30% of cases, respectively [1].
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04557-1) contains supplementary material. This video is also available to watch on http://link.springer. com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’. * Guido M. Rey Valzacchi [email protected] 1
Department of Gynecology, Hospital Italiano of Buenos Aires, Potosí 4135, Zip Code 1199 Buenos Aires, Argentina
Most are asymptomatic. However, patients may have hesitancy, frequency, dribbling, hematuria, pressure from mass effect, or urinary obstruction [2]. Findings on ultrasound evaluation are very characteristic, as bladder leiomyomas are homogeneous, smooth lesions with peripheral hyperechogenicity [1], with transperineal ultrasound being a useful tool for better assessment depending on the location of the lesion. As with uterine fibr
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