Behind the Scenes: The Silent Urethral Leiomyoma in a Young Woman Treated With Precision

Abdul Hamid T1, Elmekresh A1, Alyammahi A1, Mohammad Ali K1, Mohamed Mohsen A1, Bagheri F1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 809
Non Discussion ePosters - Case Reports
Scientific Non Discussion Poster Session 300
Anatomy Female Surgery Imaging
1. Dubai Health
Links

Abstract

Hypothesis / aims of study
Abstract
Urethral leiomyomas are rare benign tumors arising from the smooth muscle of the urethra, with fewer than 100 cases reported. They primarily affect women of reproductive age and are often asymptomatic or discovered incidentally. We present a case of a 33-year-old woman who noted a small, asymptomatic periurethral mass. MRI revealed a 1.7 × 1.4 cm lesion in the distal urethra, which was confirmed as urethral leiomyoma following cystoscopy and surgical excision. The patient had an uneventful recovery, and histopathological analysis verified complete excision. Surgical removal remains the definitive treatment, minimizing recurrence risk. This case underscores the importance of considering urethral leiomyoma in the differential diagnosis of urethral masses and highlights the role of MRI and surgery in effective management.
Study design, materials and methods
Introduction
Urethral leiomyomas are rare benign mesenchymal tumors arising from smooth muscle fibers, predominantly affecting women aged 20–50. They are often incidental findings but may present with urinary symptoms or a palpable mass. Given their rarity, diagnosis can be challenging, necessitating imaging and histopathological confirmation. Surgical excision is the treatment of choice, with minimal recurrence reported.
Results
Case Presentation
A 33-year-old woman presented with a self-detected, asymptomatic mass near the urethral opening. Physical examination revealed a firm, mobile, non-bleeding mass protruding from the posterior urethral meatus. MRI demonstrated a 1.7 × 1.4 cm enhancing lesion in the distal urethra, extending posteriorly to abut the anterior vaginal wall. Cystoscopy confirmed a 1.5 × 1.5 cm lesion on the anterior urethral wall, which was surgically excised. The postoperative course was uneventful, with complete healing and minimal post-void residual volume at follow-up. Histopathology confirmed urethral leiomyoma with no evidence of malignancy.
Interpretation of results
Discussion
Urethral leiomyomas are categorized as deep soft tissue tumors and are believed to have a hormonal influence, given their association with estrogen levels. They can be asymptomatic or present with urinary obstruction, recurrent infections, or hematuria. MRI is instrumental in preoperative assessment, while histopathology confirms diagnosis. Differential diagnoses include urethral prolapse, diverticulum, papilloma, and malignant tumors. Surgical excision is the preferred management strategy, ensuring complete removal of the lesion to prevent recurrence. Despite the rare occurrence of postoperative complications such as incontinence or urethral stenosis, this case had an excellent outcome. Long-term follow-up is recommended to monitor for potential recurrence, although malignant transformation has not been reported.
Concluding message
This case highlights the need for clinical awareness of urethral leiomyomas in the differential diagnosis of periurethral masses. MRI aids in localization and characterization, while surgical excision provides curative treatment with excellent prognosis. Further research is needed to explore the hormonal pathogenesis and to establish standardized management guidelines. Long-term surveillance remains crucial to ensure durable treatment outcomes.
Figure 1 MRI sagittal (left) and axial (right) images depicting the urethral lesion
Figure 2 Localisation and complete dissection of the urethral lesion
Figure 3 Figure 3 A: Low power view (4x)showing ulcerated urothelium with moderate chronic inflammation. B: Low power view (10x) showing spindle cell neoplasm.C : Medium power view (20x)showing spindle cell neoplasm D: High power view (40x)
References
  1. Greco, J. F., Heller, M. T., & Andreadis, S. (2020). The role of urinary biomarkers in prostate cancer detection: a review of the current literature. PMC, 8210724
  2. Jiang, L., Li, C., & Zhang, L. (2014). A case of primary urethral squamous cell carcinoma with distant metastasis. Oncology Letters, 8(5), 2073-2075
  3. Bolon, D., Cheng, C., & Glickman, S. (2016). Leiomyoma of the male urethra: A case report and review of the literature. PMC, 5141528
Disclosures
Funding nil Clinical Trial No Subjects Human Ethics not Req'd it is a case report
15/07/2025 21:32:50