Paraurethral leiomyoma in a post-menopausal woman: a case report

Paraurethral leiomyoma are rare, benign, hormone-dependent growths. They originate from smooth muscle cells and occur in the paraurethral space of the urethra. They make up approximately 5% of urethral tumours. They usually appear in the reproductive age group of women with variable clinical presentation depending on the size and location of occurrence. They can either be asymptomatic or can present with local pressure symptoms, dyspareunia, and lower urinary tract symptoms. The usual treatment is surgical excision with confirmation of diagnosis on histology.

We report a case of a 58-year-old lady who initially presented to the gynaecology department with pelvic pain and lower urinary tract symptoms. After initial investigation with an ultrasound scan and MRI, a 5 × 5 × 4 cm mass was detected next to the bladder, with suspicions of it arising from the detrusor muscle. There was also a 3 cm Bartholin’s cyst detected in the left vaginal wall. Her care was referred to the urology team who after further investigation and a transperineal biopsy of the mass diagnosed a paraurethral leiomyoma on histology. Given the patient was symptomatic, she opted for treatment. Embolisation was explored but was deemed not feasible due to a complex blood supply. Therefore, the patient underwent an open excision of leiomyoma as a combined abdominal and vaginal procedure.

Paraurethral leiomyoma are rare benign lesions and therefore pose diagnostic challenges as they must be differentiated from malignant tumours. Radiological imaging aids with diagnosis but diagnosis is confirmed on histology. The mainstay of treatment is surgical excision. This case is unusual given the patient’s age and post-menopausal status as the average age of presentation in the literature is 41 years old. The authors would recommend initial USS imaging for all patients presenting with overactive bladder symptoms and pelvic pain/discomfort.