ONLINE APPENDIX B

Previously published case reports and case series on urinary retention in women with uterine leiomyoma

Study* / Year / Country / Age / G / P / Symptom presentation / Physical finding / Diagnostic studies / Treatment / Pathology / Time from symptom onset to diagnosis / Outcome
Grossman24 / 1978 / US / 45 / 2 / 2 / AUR with overflow × 4 days, premenstrual AUR × 3 months / 14-week sized, irregular, firm uterus / NR / TAH / Multiple myomas, 370g uterus / 3 months / Postoperative resolution
Kondo25 / 1982 / Japan / 45 / 1 / 1 / AUR requiring catheterization × 2, lower abdominal pain / Anteverted uterus, large impacted myoma / Cystoscopy: elevated retrotrigonal area elevated
Urethral pressure profile: shortened functional profile length of 27mm and maximum urethral closure pressure of 63cm H2O / TAH BSO / 10cm diameter myoma in left corpora of uterus / NR / Postoperative resolution,
Friedman15 / 1993 / US / 53 / 2 / 2 / Pelvic pressure, constipation, menorrhagia, rapid increase in uterine size after GnRH agonist administration / 16-week sized, mobile uterus, anterior cervix / U/S: 20.0×8.3×15.7cm uterus, multifibroid; largest myoma in posterior fundus 11.00×8.2×10.0cm‡ / TAH BSO / Multiple myomas, 591g uterus / NR / NR
Abi Aad2 / 1996 / Belgium / 32 / 0 / 0 / Difficulty voiding × 1 month, AUR requiring catheterization × 2 / Very large and smooth mass at vaginal palpation / U/S: large retrovesical mass
CT: endometrial mass 11cm diameter, distal part of mass in close contact of bladder outlet / TAH / 600g leiomyoma / NR / Immediate postoperative resolution
Yu23 / 2001 / Taiwan / 40 / NR / NR / Recurrent episodes of AUR, lower abdominal pain, hesitancy, straining with voids, menorrhagia / NR / U/S/MRI: 375cm2pedunculated mass in lower segment of uterus / Goserelin, hysteroscopicmyomectomy / 2750g leiomyoma / NR / Postoperative resolution
Yang 111 / 2002 / Taiwan / 45 / 4 / 3 / Early morning AUR / Pelvic mass occupying the cul-de-sac / U/S: leiomyoma 9.7×7.1cm
Bladder neck position: 83° at rest, 143° during straining, 107° standing / Hysterectomy (type not specified) / NR / NR / NR
Yang 211 / 2002 / Taiwan / 51 / 2 / 2 / Midnight and early morning AUR / Pelvic mass occupying the cul-de-sac / U/S: leiomyoma 7.9×7.8cm
Bladder neck position: 105° at rest, 145° during straining, 115° standing / Conservative / N/A / NR / Symptomatic improvement
Yang 311 / 2002 / Taiwan / 41 / 0 / 0 / Midnight AUR / Pelvic mass occupying the cul-de-sac / U/S: leiomyoma 9.0×9.8cm
Bladder neck position: 96° at rest, 125° during straining, 110° standing / Conservative / N/A / NR / Symptomatic improvement
Shozu20 / 2003 / Japan / 53 / 4 / 2 / Difficulty urinating × 6 months; AUR requiring catheterization × 3days / 20-week sized uterus impacted in the pelvis, with a protrusion compressing the bladder / U/S/MRI: intramural leiomyoma in left posterior wall of uterus 10.5×10×8.2cm; multifibroid uterus / Aromatase inhibitor fadrozole / N/A / NR / Symptom resolution
Novi26 / 2004 / US / 46 / NR† / NR† / AUR × 12 hours, increasing pelvic pressure, urinary frequency × 2 years / 18-20 week sized uterus, large posterior myoma displacing the cervix anteriorly / U/S: homogeneously enlarged uterus with multiple leiomyomas / TAH BSO / NR / NR / Immediate postoperative resolution
Barnacle 16 / 2007 / US / 48 / 4 / 3 / Intermittent AUR × 2 years, difficulty emptying, void with strong Valsalva, needs to void q3-4h to avoid retention; pelvic pressure and pain / 16-18 week size uterus, cervix not visualized due to anterior deflection, large posterior myoma / U/S: largest posterior fibroid 8.2cm / TAH / NR / 2 years / Immediate postoperative resolution
Barnacle 26 / 2007 / US / 48 / 0 / 0 / Repeated AUR during menses × 1 year, difficulty emptying / 16-week size uterus, large posterior myoma / MRI: 11.3cm posterior leiomyoma with evidence of bladder neck compression by displaced uterus / TAH / NR / 1 year / Immediate postoperative resolution
Hosokawa27 / 2005 / Japan / 44 / NR / NR / Several episodes of AUR requiring catheterization / Pelvic mass / MRI: large uterine myoma pressing the bladder toward the abdominal wall / TAH / 700g uterus / NR / Immediate postoperative resolution
Maimoon28 / 2006 / India / 40 / NR / NR / History of multiple episodes of urinary retention relieved with catheterization / Suprapubic fullness / U/S: multinodular fibroid arising from the lower part of posterior wall of the uterus / TAH USO / Cotyledonoidleiomyoma 12×10×9cm / NR / NR
Arleo29 / 2008 / US / 39 / 2 / 2 / AUR ×18 hours / Uterine leiomyoma / MRI: leimyomatous uterus 8.0×9.6×9.9cm with dominant intramural fibroid 8.5×7.2×7.9cm / UFE|| / NR / NR / Immediate post-UFE resolution
Ding16 / 2008 / Taiwan / 45 / 3 / 2 / Intermittent AUR x 1 year, difficulty emptying, had to void q3-4h +/- Valsalva / 12-week size uterus, cervix could not be visualized due to anterior deflection, large posterior myoma / U/S: retroverted uterus with 5.7×4.3cm posterior myoma compressing the lower portion of the bladder / TLH / NR / 1 year / Immediate postoperative resolution
Haskal 122 / 2008 / US / 48 / 2 / 1 / Multiple episodes of AUR × 1 month, bloating, urinary frequency × 6 months / Uterus palpable below the umbilicus / MRI: 9×12×10cm uterus with multiple fibroids; largest in lower body of the uterus 7.4×7.1×6.3cm / UFE¶ / NR / 6 months / Immediate post-UFE resolution
Haskal 222 / 2008 / US / 49 / 2 / 2 / Intermittent AUR × 2 months, pelvic fullness × 2 years / 14-week size uterus / MRI: dominant enhancing intramural ventral fibroid 8.5×6.7×8.2cm; uterus 10.4×12.6×10cm in size / UFE¶ / NR / 2 years / Immediate post-UFE resolution
Derbent21 / 2009 / Turkey / 36 / 0 / 0 / AUR x 10 hours, abdominal pain, frequency, difficulty emptying × 3months / Retrovertedenlarged uterus / U/S: 13×9cm heterogenous, hypoechoicmyoma arising from the anterior and fundal walls of the uterus; dilated right renal calyx / Myomectomy by laparotomy / 11×9.5×5cm leiomyoma / 3 months / Immediate postoperative resolution
Mavromatidis17 / 2009 / Greece / 47 / 1 / 1 / Difficulty voiding × 2 weeks, abdominal distension / Uterus increased in size / U/S: 20.2×16.8×12.8cm uterus, largestmyoma in posterior lower segment of the uterus 10.3×9.8×8.7cm and caused anteflexion of the uterine cervix, which compressed the bladder neck / TAH BSO / Uterine fibroid / NR / Uneventful postoperative course
Mahdy18 / 2010 / US / 52 / 3 / 3 / Intermittent AUR, particularly during menses, recurrent voiding difficulty × 3 months / 14-16 weeks size pelvic mass / U/S+MRI: large intramural posterior myoma 6.8×6.5cm, multiplemyoma
UFS: maximum flow rate of 6.1ml/s, prolonged and interrupted flow.
Cystourethroscopy: extramural retro-vesical mass that pushes the bladder base and trigonal areas anteriorly / Laparoscopic supra-cervical hysterectomy / Uterine leiomyoma / 3 months / Immediate postoperative resolution
Yazdany 112 / 2012 / US / 25 / NR / NR / Difficulty with voiding and defecation × 3 months, worse with menses / 20 weeks sizeanteverted uterus, large posterior mass / U/S: 12×11cm uterus, 11cm fundal leiomyoma
Cystoscopy: deviation to right noted
Urodynamics: increased bladder pressure at 300cc capacity / Abdominal myomectomy / 460g leiomyoma with 2/10 mitotic index / 7 months / Immediate postoperative resolution
Yazdany 212 / 2012 / US / 29 / NR / NR / AUR / Unable to visualize cervix, large posterior mass filling cul-de-sac / U/S: 9×9cm posterior leiomyoma, 7×6 fundal leiomyoma / Abdominal myomectomy** / 630g necrotic leiomyoma / 2 months / Immediate postoperative resolution
Yazdany 312 / 2012 / US / 33 / NR / NR / Intermittent AUR, recurrent UTIs, pyelonephritis, poorly controlled diabetes / Large posterior mass filling cul-de-sac / U/S: 7×6cm posterior leiomyoma, anteverted uterus
CT: markedly distended bladder, hydronephrosis / TAH / 330g uterus, multiple leiomyoma / 4 months / Resolution after discharge
Yazdany 412 / 2012 / US / 36 / NR / NR / AUR, recurrent UTIs, urgency, intermittent voiding difficulty × 2 years / Large posterior mass filling cul-de-sac / U/S: 16×10cm uterus, 9×8cm myoma
CT: mass effect displacing bladder anteriorly causing compression
Cystoscopy: mass indent in dome
Urodynamics: overactive bladder, stress urinary incontinence / TAH / 900g uterus, leiomyoma / 1 year and 9 months / Immediate postoperative resolution
Yazdany 512 / 2012 / US / 44 / NR / NR / AUR / Unable to visualize cervix, large posterior mass filling cul-de-sac / U/S: 11×10cm uterus, 7.5×6.5cm fundal leiomyoma / TAH USO / 400g uterus, leiomyoma / 2 weeks / Urgency at postoperative visit, resolved at 3 month visit
Yazdany 612 / 2012 / US / 44 / NR / NR / Intermittent AUR, post-void fullness, schizophrenia, cocaine use / Unable to visualize cervix, large posterior mass filling cul-de-sac / U/S: 14×11×26cm uterus, central myoma 11×11.6×11.7cm, pedunculated fundal 7×6.4×6.6cm
CT: bladder displaced superior and lateral / TAH RSO / 700g uterus, leiomyoma / 3 months / Immediate postoperative resolution
Yazdany 712 / 2012 / US / 50 / NR / NR / AUR / Unable to visualize cervix, large posterior and fundal myoma / CT: 11×12cm uterine mass; bladder displaced to anterior and right location
Urodynamics: high bladder capacity / TAH / 1000g uterus, leiomyoma / 2 weeks / Immediate postoperative resolution
Yazdany 812 / 2012 / US / 51 / NR / NR / AUR preceded by voiding difficulty × 1 month / Unable to visualize cervix, retroverted uterus, / U/S: 10×9×15cm uterus, 5.8×4.4cm complex adnexal mass / TAH BSO / 440g uterus, leiomyoma, teratoma§ / 5 weeks / Immediate postoperative resolution
Chu13 / 2013 / US / 50 / NR / NR / 2 episodes of AUR × 1 week, difficulty voiding, interrupted flow of urination, UTIs / Anteverted uterus, large posterior fibroid filling the cul-de-sac / U/S: 13.9×10.7×9.6cm uterus, central dominant myoma 10×8.9×9cm / Depot leuprolide acetate / N/A / NR / Resolution
Andrada19 / 2014 / Spain / 48 / NR / NR / Several episodes of AUR × 3 months, frequency, incomplete emptying, difficulty initiating void / Absence of the bulbocavernous reflex / U/S: prominent leiomyoma
Cystoscopy: retrovesical mass protruding into the bladder base
Multichannel cystometry: acontractiledetrusor muscle
Needle electromyogram: neurogenic lesion compatible with chronic motor polyradiculopathy of S1 and S2 nerve roots
MRI: enlarged uterus, multiple intramural leiomyomas; largest in posterior left wall 6.5×6cm / TAH / NR / 3 months / Resolution
Abbreviations: AUR = acute urinary retention; BSO = bilateral salpingo-oophorectomy; CT = computed tomography; MRI = magnetic resonance imaging; N/A = not applicable; NR = not reported; RSO = right salpingo-oophorectomy; TAH = total abdominal hysterectomy; TLH = total laparoscopic hysterectomy; UFE = uterine fibroid embolization; UFS = uroflow study; US = United States; U/S = ultrasound; USO = unilateral salpingo-oophorectomy; UTI = urinary tract infection.
*Studies are listed according to their year of publication, from the earliest to the most recent. †Multiparous. ‡GnRH-agonist administration led to a 64% increase in uterine volume and 79% increase in myoma size within 1 week. §Patient also had a 9cm cervical leiomyoma. ||Uterine fibroid embolization with 500-700μm Spherical polyvinyl alcohol particles. ¶Uterine fibroid embolization with 500-700μm Embosphere particles. **Patient failed uterine artery embolization prior to hysterectomy.