Pelvic plexus compression due to a uterine leiomyoma in a woman with acute urinary retention: a new hypothesis

Abstract

Acute urinary retention (AUR) in women is an uncommon occurrence described by the International Continence Society (ICS) as a painful, palpable, or perceptible bladder when the patient is unable to pass urine. Contrarily to men, AUR in women is not usually due to any obstructive process. Neurologic causes are the most common reason for AUR in reproductive-age women. A few case reports have been published concerning women suffering from gynecological pathology and AUR, and they propose extrinsic compression of the urinary tract. In the case we report, AUR pathophysiology was compression of the pelvic plexus by a giant uterine leiomyoma. An electromyogram displayed motor polyradiculopathy of S1 and S2 nerve roots, and the patient was unable to urinate due to an uncontractible bladder.

A Case of Female Acute Urinary Retention Presenting to the ED

“…They concluded that obstruction of the internal urethral orifice was as a result of compression of the lower bladder from displacement of the cervix and not due to compression or distortion of the urethra itself [8]. Another case report demonstrated electromyographic evidence of pelvic plexus compression by a uterine fibroid resulting in acute urinary retention [9]. Other pathophysiologic theories explaining urinary retention secondary to uterine leiomyoma include the “vascular steal effect , ” where blood is shunted away from the urogenital system resulting in detrusor muscle hypocontractility and urinary retention as a consequence.…”

Female detrusor underactivity: Two uterine leiomyoma cases

“…UL may cause either overactive bladder or retention 2–7 . We showed that UL caused detrusor underactivity in two cases, and both ameliorated after removal of UL (based on follow‐up findings in case 1).…”

“…Only two urodynamics reports of UL 1–5 have been published to date, in which Andrada et al 6 . showed detrusor underactivity and sphincter EMG abnormality, and Huang et al 7 .…”

Acute urinary retention due to a large isthmic leiomyoma – a case report and literature review

“…However, any other condition which might lead to the uterine impactation in the bony pelvis might induce acute urinary retention (9). Other incriminated mechanisms are related to pelvic congestion due to hormonal modifications during menstruation, detrusor ischemia due to fibroid compression or nervous compression due to fibroid compression (10,11).…”