Transurethral resection of a bladder trigone leiomyoma: a rare case report
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CASE REPORT
Transurethral resection of a bladder trigone leiomyoma: a rare case report Athanasios Zachariou1* , Maria Filiponi1, Fotios Dimitriadis2, Aris Kaltsas1 and Nikolaos Sofikitis1
Abstract Background: Bladder leiomyomas are rare and benign tumors of the bladder. They account for 0.43% of all bladder tumors, and only 250 cases have been reported in English literature. Based on the size and localization of the lesion, their symptoms vary considerably. Women seem to be more affected, and obstructive symptoms predominate. Surgical treatment is almost always highly effective, leaving a low recurrence rate. Case presentation: We present a clinical case of a 52-year old man with macroscopic hematuria and obstructive lower urinary tract symptoms due to a large bladder trigone leiomyoma. CT and MRI showed a well-defined large bladder leiomyoma and cystoscopy established the initial findings. The patient underwent successful transurethral resection of the lesion, and pathology findings confirmed the diagnosis. Conclusions: This case report demonstrates that transurethral resection of a large bladder trigone leiomyoma is a feasible and successful procedure. Long term follow-up proves that there is neither scarring distortion of the bladder trigone area nor damage in the ureteral orifices, even though there was a thorough removal of the trigone wall. Keywords: Bladder, Trigone, Leiomyoma, Obstruction, Transurethral resection Background Leiomyoma describes a benign growth of smooth muscle tissue. These tumors can occur anywhere in the body where smooth muscle is found, but are frequently located in the uterus (commonly called fibroids) or the gastrointestinal tract. Bladder leiomyoma is a rare, benign tumor with an incidence rate of about 0.43% among all types of bladder tumors [1]. Approximately 250 cases have been reported to date to English literature, including patients who had leiomyoma in a urethral location [2]. Some of the leiomyomas observed in the bladder are diagnosed accidentally, and these patients could have a variety of clinical presentations such as obstructive symptoms from the lower urinary tract, irritative symptoms, hematuria, and dysuria. Surgery is the standard treatment, and the
surgical approach depends on tumor size and location at the bladder wall. Small and easily accessible tumors can be treated with transurethral resection of the bladder tumor, while an unfavorable location may require segmental resection or laparoscopic partial cystectomy [3]. Here we report a case of a large bladder trigone leiomyoma in a 52-year-old Caucasian male who presented with complaints of lower urinary tract obstruction, sporadic hematuria, and dysuria. To our knowledge, this case is one of the few reported cases of bladder trigone leiomyoma mimicking the median prostate lobe and distorting the left ureteric orifice. Our primary concern was that scar tissue following the procedure could further change the bladder trigone area, thus exacerbating patient’s dysuria.
*Correspondence: zahariou@oten
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