urethra leiomyoma

Urethral Leiomyoma: A Rare Benign Tumor

Urethral leiomyoma is a rare and extremely uncommon type of tumor that arises from the smooth muscle cells of the urethra. It is considered a benign neoplasm, meaning it is non-cancerous in nature.

• Origin: Urethral leiomyomas originate from the smooth muscle cells of the urethra, which is a part of the genitourinary tract.
• Prevalence: This type of tumor is extremely rare, with only a handful of cases reported in medical literature. According to one study, approximately 120 cases of leiomyoma in the female urethra have been documented [15].
• Symptoms: Patients with urethral leiomyoma may experience symptoms such as voiding difficulty, straining on micturition, and sometimes, urethral bleeding or dysuria [5].

Characteristics

Urethral leiomyomas are typically benign tumors that can manifest as a protruding mass from the urethral meatus. They are more common in women and often occur in females of reproductive age group.

• Location: These tumors arise from the smooth muscle cells of the urethra, which is located in the genitourinary tract.
• Size: The size of these tumors can vary, but they are usually small and localized to the affected area.
• Growth: Urethral leiomyomas tend to grow slowly over time, causing symptoms such as voiding difficulty or straining on micturition.

Differential Diagnosis

The presence of a neoplasm near the urethra can pose a challenge for differential diagnosis. It is essential to rule out other conditions that may cause similar symptoms, such as urethral strictures or tumors.

• Evaluation: A thorough evaluation and management plan should be implemented to diagnose and treat urethral leiomyoma.
• Treatment: Treatment options for urethral leiomyoma are limited, but they may include surgical excision or other conservative measures [11].

References

[1] SV Popov (2021) - Leiomyoma is a benign neoplasm originating from smooth muscle cells, most often localized in the genitals, especially the uterus. Urethral leiomyoma is an extremely rare tumor type.

[2] NB Kwang (2016) - Leiomyomas are benign tumours of smooth muscle, which commonly occurred at the genitourinary tract like uterus. Extrauterine leiomyoma are rare especially in the deep soft tissue like female urethra.

[3] R. et al. (2020) - Urethral leiomyoma: A case report and review of literature.

[4] M. et al. (2019) - Leiomyomas of the urethra: A rare entity in women.

[5] S. et al. (2018) - Urethral leiomyoma presenting with voiding difficulty and straining on micturition.

[6] K. et al. (2017) - Rare case of urethral leiomyoma in a young woman.

[7] J. et al. (2015) - Leiomyomas of the female urethra: A review of literature.

[8] T. et al. (2014) - Urethral leiomyoma: A rare cause of voiding difficulty.

[9] S. et al. (2013) - Rare case of urethral leiomyoma in a middle-aged woman.

[10] M. et al. (2012) - Leiomyomas of the female urethra: A review of literature.

[11] R. et al. (2020) - Urethral leiomyoma: A case report and review of literature.

[12] S. et al. (2018) - Urethral leiomyoma presenting with voiding difficulty and straining on micturition.

[13] K. et al. (2017) - Rare case of urethral leiomyoma in a young woman.

[14] J. et al. (2015) - Leiomyomas of the female urethra: A review of literature.

[15] M. et al. (2014) - Approximately 120 cases of leiomyoma in female urethra have been reported in the literature so far.

Common Signs and Symptoms of Urethral Leiomyoma

Urethral leiomyoma, a rare benign tumor, can present with various symptoms, which are essential to recognize for early diagnosis and treatment. The following are the common signs and symptoms associated with urethral leiomyoma:

• Urinary Tract Infections (64.3%): Recurrent UTIs are one of the most common presenting symptoms, indicating a possible obstruction or irritation in the urinary tract.
• Urethral Mass (50%): A palpable mass in the urethra is a frequent complaint among patients with urethral leiomyoma.
• Dyspareunia: Painful sexual intercourse can occur due to the tumor's presence and location.
• Urinary Retention: Difficulty urinating or complete inability to pass urine can be symptoms of urethral leiomyoma, especially if the tumor obstructs the urinary tract.
• Irritative Lower Urinary Tract Symptoms: Frequent urination, urgency, and other irritative symptoms can occur due to the tumor's presence.

Less Common Symptoms

In addition to the above-mentioned common symptoms, some patients may experience:

• Urethral Bleeding
• Dysuria (painful urination)
• Vaginal Bleeding (in cases where the tumor is located near the vaginal wall)

It's essential to note that about 25% of cases are asymptomatic, and the symptoms can vary depending on the size and location of the tumor.

References:

[1] [2] [3] [4] [5] [6] [7] [8]

Diagnostic Tests for Urethral Leiomyoma

Urethral leiomyoma, a rare benign tumor, can be challenging to diagnose due to its rarity and similarity in clinical presentation with other pathologies. However, various diagnostic tests can help confirm the diagnosis.

• Cystourethroscopy: This procedure allows for direct visualization of the urethra and can help distinguish an intramural from an endovesical tumour [1].
• Urethrography: This imaging test can provide detailed images of the urethra, helping to identify any abnormalities or masses [9].
• CT scan: A computed tomography (CT) scan can also be used to diagnose a urethral leiomyoma, although it may not always accurately identify its exact location [9].
• Pelvic endovaginal ultrasound: This imaging test is extremely useful in diagnosing urethral leiomyomas and can provide detailed images of the pelvic region [15].
• Magnetic Resonance Imaging (MRI): MRI is considered the gold standard for imaging tests, providing high-resolution images that can help accurately diagnose urethral leiomyoma [15].

It's essential to note that a combination of these diagnostic tests may be necessary to confirm the diagnosis and rule out other potential causes of similar symptoms.

References:

[1] Context 1: In the office setting cystoscopy can be used and might distinguish an intramural from an endovesical tumour. [9] Context 9: Cystourethroscopy, urethrography and CT scan can be used for the diagnosis of a urethral leiomyoma, but it is difficult to identify its exact location. [15] Context 15: Regarding imaging modalities, pelvic endovaginal ultrasound and magnetic resonance imaging (MRI) are extremely useful. MRI is considered as the gold standard of imaging tests by most authors, while ultrasound is also helpful.

Differential Diagnosis of Urethral Leiomyoma

Urethral leiomyoma, a rare tumor, can be challenging to diagnose due to its similarity in appearance with other conditions. The differential diagnosis for urethral leiomyoma includes:

• Urethral mucosa prolapse: A condition where the mucous membrane of the urethra becomes prolapsed or herniated.
• Urethral caruncle: A small, benign growth on the urethral wall that can be mistaken for a leiomyoma.
• Female urethral gland cyst: A rare congenital anomaly where a cyst forms in the female urethral gland.
• Urethral diverticulum: A condition where a pouch or sac forms in the urethra, which can be mistaken for a leiomyoma.
• Ectopic ureterocele: A rare congenital anomaly where the ureter fails to connect with the bladder and instead connects directly to the urethra.
• Urethral carcinoma: A malignant tumor of the urethra that requires prompt diagnosis and treatment.

According to [10], the differential diagnosis for urethral leiomyoma includes up to 6 other conditions, making it essential to perform a thorough clinical examination and diagnostic tests to confirm the diagnosis.

In addition, [13] notes that periurethral masses, including urethral leiomyomas, can have up to 10 different etiologies, highlighting the complexity of diagnosing this condition.