Giuseppe Ciravolo1, Federico Ferrari2, Valentina Zizioli1, Paolo Donarini1, Sara Forte3, Enrico Sartori3, Franco Odicino3. 1. Department of Obstetrics and Gynecology, Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. 2. Department of Obstetrics and Gynecology, Spedali Civili Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. f.ferrari.obgyn@gmail.com. 3. Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
Abstract
INTRODUCTION AND HYPOTHESIS: A 42-year-old female presented with a 12-cm mass bulging the anterior vaginal wall and causing urgency urinary incontinence and bulk symptoms. METHODS: Imaging showed a tumor originating from the dorsal and cranial part of the urethra and developing in the vesicouterine space and vesicovaginal septum, dislocating the bladder ventrally and the uterus cranial-dorsally. RESULTS: Tranvaginal biopsy showed a benign leiomyoma. A laparoscopic approach with development of the vesicouterine space permitted a safe partial morcellation of the myoma. After the bladder and vaginal wall had been completely freed, further caudal dissection was conducted with isolation of the distal cranio-dorsal portion of the urethra. The dissection plane with the vaginal wall was developed up to the caudal margin of the urethral myoma almost corresponding to the vulvar plane, and total excision of the lesion was performed. CONCLUSION: Laparoscopic management of urethral leiomyomas that develop into the vesicouterine space and vesicovaginal septum is feasible and safe also for very large lesions.
INTRODUCTION AND HYPOTHESIS: A 42-year-old female presented with a 12-cm mass bulging the anterior vaginal wall and causing urgency urinary incontinence and bulk symptoms. METHODS: Imaging showed a tumor originating from the dorsal and cranial part of the urethra and developing in the vesicouterine space and vesicovaginal septum, dislocating the bladder ventrally and the uterus cranial-dorsally. RESULTS: Tranvaginal biopsy showed a benign leiomyoma. A laparoscopic approach with development of the vesicouterine space permitted a safe partial morcellation of the myoma. After the bladder and vaginal wall had been completely freed, further caudal dissection was conducted with isolation of the distal cranio-dorsal portion of the urethra. The dissection plane with the vaginal wall was developed up to the caudal margin of the urethral myoma almost corresponding to the vulvar plane, and total excision of the lesion was performed. CONCLUSION: Laparoscopic management of urethral leiomyomas that develop into the vesicouterine space and vesicovaginal septum is feasible and safe also for very large lesions.
Authors: Paolo Fedelini; Francesco Chiancone; Maurizio Fedelini; Marco Fabiano; Francesco Persico; Domenico Di Lorenzo; Clemente Meccariello Journal: Urologia Date: 2017-02-28