Leiomyoma of the urinary bladder is a very rare entity and represents < 0.5% of all bladder tumours, with only 250 cases reported worldwide to date. We report a case of leiomyoma of the bladder 55 -year-old female presented with chief complaints lower abdomen pain since 1 year associated with intermittency, burning, frequency and hesitancy in micturation. Bimanual examination of the patient revealed a mass on the right side near the bladder neck. USG suggested a well circumscribed polypoidal soft tissue lesion seen projecting in urinary bladder lumen and attached to the posterior wall and base of bladder with no internal vascularity. On cystoscopic examination, large smooth sessile growth arising from the right postero-lateral wall was noted with right ureteric orifice not visualized. Magnetic resonance imaging showed Large well defined rounded soft tisssue lesion close to anterior surface of the cervix and vagina which was Isointense to the skeletal muscles on T1 and T2 images with small focal irregular cystic areas of necrosis seen. It could be urinary bladder neoplasm or sub serosal cervical fibroid. Transurethral resection of tumor was performed. The pathologic diagnosis was leiomyoma of the bladder. We discuss the diagnosis and management of leiomyoma of the bladder and briefly review the literature.
Introduction and Objectives:
Buccal mucosal graft (BMG) is frequently used for the reconstruction of urethral strictures with acceptable donor-site morbidity after graft harvest. There are only a few prospectively designed studies with a small number of patients reporting oral complications, particularly the mouth opening in the long terms. We did an objective assessment of mouth opening before and after 6 months of BMG urethroplasty as well as pain scores.
Materials and Methods:
Fifty-eight patients who underwent BMG urethroplasty were included in the study between May 2013 and December 2014. Preoperative mouth opening (reference point between two incisors with the highest of three readings taken as final) was measured using a Vernier caliper. Harvest site was left open to heal by secondary intentions. Postoperatively, mouth opening and pain scores using self-administered (Visual Analog Scale [VAS]) assessed on day 1 and day 3, and follow-up at 1 week, 1 month, and 6 months. Data were analyzed as mean (standard deviation [SD]), proportion, and median (inter-quartile range [IQR]) with two-tailedP < 0.05 as statistically significant.
Results:
The mean age was 39.6 years. The graft was harvested from a single cheek in 50% of patients. In remaining, it was taken from both cheeks, both cheeks with lip, and both cheeks with the tongue in 29.31%, 17.24%, and 3.5%, of patients, respectively. Preoperative mouth opening (5.13 cm [0.08]) was statistically significantly more than mouth opening on day 1 (4.34 cm [0.09]), day 3 (4.48 [0.09]), and day 7 (4.69 cm [0.09]). Mean difference became insignificant at the interval of 1 month (4.91 cm [0.09]) with 6 months’ values showing marginal improvement over preoperative values (5.14 cm [0.07]). Pain was tolerable and patients reported low median VAS 2 (2–4) on day 1 and day 3 each. Reported median VAS became 0 (0–0) on day 7.
Conclusion:
Mouth opening restriction after BMG urethroplasty is a definite entity in the initial postoperative period, which becomes nonsignificant by 6 months. The pain has no effect on mouth opening.
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