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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 1999 March;51(1):33-8

language: Italian

Leiomyoma of the uri­nary blad­der. A ­case re­port and re­view of the lit­er­a­ture

Greco A., Baima C., Piana P.

Università degli Studi - Torino Dipartimento di Discipline Medico-Chirurgiche Divisione di Patologia Urologica (Direttore: Prof. A. Tizzani)


Mesoidial tu­mours are ­rare be­nign le­sions ­which may oc­cur ­wherever me­sen­chy­mal tis­sues are ­present ­with an in­ci­dence of ­between 1.5% and 5%. Above all, leiom­yo­mas af­fect fe­males af­fect fe­males ­aged ­between 30 and 50 ­years old and ­show a pref­er­ence for the uter­us (­most fre­quent­ly ob­served ­site) and the di­ges­tive and uri­nary ­tracts, in par­tic­u­lar the ves­ci­ca. Their eti­ol­o­gy is ­still con­tro­ver­sial, but the hy­poth­e­sis of tu­mo­ral ­growth fol­low­ing an al­tered re­sponse to hor­mone stim­u­la­tion (spt. Estrogens) ap­pears to be the ­most cred­ible. Development is main­ly en­do­ves­ci­cal (63%), but ex­tra­ves­ci­cal (30%) and intra­mu­ral cas­es are not ­rare; the ­site and di­men­sions (­mean 6 cm) in­flu­ence the symp­toms, the ­type of sur­gery and the prog­no­sis. In intra­ves­ci­cal cas­es the ­most com­mon­place symp­toms in­clude ob­struc­tive uri­na­tion, in­clud­ing pre-uri­na­tion de­lay, a feel­ing of in­com­plete emp­ty­ing, diur­nal pol­la­kiu­ria; ­these are fol­lowed by ir­ri­ta­tive symp­toms (dys­uria, burn­ing) and mi­cro-mac­ro­scop­ic hem­a­tu­ria. They are of­ten asymp­to­mat­ic in oth­er cas­es. Diagnosis is ­based on in­stru­men­tal di­ag­no­sis, in par­tic­u­lar ultra­so­nog­ra­phy us­ing a su­pra­pu­bic and/or trans­vag­i­nal ap­proach, ­which ­gives an hy­po­ech­o­gen­ic im­age cov­ered by a ­thin hy­per­ech­o­gen­ic ­line of mu­co­sa. Diagnosis can al­so be ­made us­ing CAT and, in ­some cas­es, MR for a bet­ter def­i­ni­tion of the ­site, di­men­sions and ra­tios. Urethrocystos­co­py is essential in asymptomatic cases and allows biopsy to be performed in uncertain cases. Treatment is surgical using a transurethral approach in endovescical cases with limited dimensions or open surgery in others. Depend-ing on timely treatment, prognosis is good owing to the low number of recidivations.

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