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Vaginal Myomectomy to Resolve Bladder Outlet Obstruction 50 Years After Hysterectomy

Johansson, Shorty, MD, MC, USAF; Walters, Rustin, MD, MC, USN; Mayer, Kaitlyn, MD, MC, USN; Shippey, Stuart, MD, MC, USN

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p e26–e28
doi: 10.1097/SPV.0000000000000571
Case Reports

Background Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence.

Case Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence.

Conclusion Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.

We report the vaginal resection of a nonpalpable, but symptomatic 2-cm bladder leiomyoma in a 77-year-old woman using abdominal ultrasound guidance.

From the Naval Medical Center, Portsmouth, VA.

Correspondence: Shorty Johansson, MD, MC, USAF, 620 John Paul Jones Cir, Portsmouth, VA 23708. E-mail:

Financial support: None.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Air Force, Department of Defense, or the United States Government.

Copyright Statement: We are military service members. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.

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