Skip to main content

Advertisement

Log in

Urological complications of uterine leiomyoma: a review of literature

  • Urology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Introduction

Uterine leiomyomas are common gynecologic tumor in reproductive-aged women, by age 50, diagnosis shared by urologist, gynecologists and radiologists.

Objective

The goal of this article is to review the current literature, study the impact of leiomyoma on female lower urinary tract, examine the cause female sexual dysfunction and provide a comprehensive review of current diagnostic, imaging studies, and current treatment of leiomyoma.

Methods

Clinical leiomyoma studies published from 1956 through 2015 were identified using the PubMed search engines and the key words leiomyoma, fibroid in the current literature. Impact of leiomyoma on the lower urinary tract including female sexual dysfunction was reviewed with terms of “urinary retention”, “bladder”, “urethra”, “dyspareunia”, “incontinence”, “incomplete bladder emptying”, “female sexual dysfunction”, and “lower urinary tract” to study the urological and sexual effects of leiomyoma. Literature related to leiomyoma was reviewed from 1965 to present.

Results

Women with uterine leiomyomata complained of pelvic pain, menstrual irregularities, infertility, lower urinary tract symptoms and sexual dysfunction.

Conclusion

Leiomyoma is a common tumor of the uterus that often clinically impacts on the lower urinary tract and results in urological and sexual symptoms. Leiomyoma can compress and grow into and become adherent to the bladder and surrounding pelvic organs or metastasize into peritoneal organs. Leiomyoma can enlarge and compress the urinary bladder, urethra, and lower end of the ureters. Leiomyoma can cause embarrassing sexual dysfunction in females. Current literature of non-surgical and surgical therapy of leiomyoma is described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

ECM:

Extracellular matrix

Bcl-2:

Beta cell lymphoma-2

GPER:

G-protein estrogen receptors

AUR:

Acute urinary retention

LUTS:

Lower urinary tract symptoms

BN:

Barrington’s nucleus

References

  1. Purohit P, Datta S, Narvekar N (2015) Open power morcellation. Obstet Gynaecol Reprod Med 25(7):208–209

    Article  Google Scholar 

  2. Feingold-Link L et al (2014) Enhancing uterine fibroid research through utilization of biorepositories linked to electronic medical record data. J Womens Health (Larchmt) 23(12):1027–1032

    Article  Google Scholar 

  3. Bulun SE et al (2015) Uterine leiomyoma stem cells: linking progesterone to growth. Semin Reprod Med 33(5):357–365

    Article  CAS  PubMed  Google Scholar 

  4. Mehine M et al (2014) Genomics of uterine leiomyomas: insights from high-throughput sequencing. Fertil Steril 102(3):621–629

    Article  CAS  PubMed  Google Scholar 

  5. Van Voorhis B (2009) A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA 301(1):82–93

    Article  PubMed  Google Scholar 

  6. Moravek MB et al (2015) Ovarian steroids, stem cells and uterine leiomyoma: therapeutic implications. Hum Reprod Update 21(1):1–12

    Article  PubMed  Google Scholar 

  7. Valle R, Ekpo G (2015) Pathophysiology of uterine myomas and its clinical implications. In: Tinelli A, Malvasi A (eds) Uterine myoma, myomectomy and minimally invasive treatments. Springer, Berlin, pp 1–11

    Google Scholar 

  8. Csatlos E et al (2015) Role of Apoptosis in the development of uterine leiomyoma: analysis of expression patterns of Bcl-2 and Bax in human leiomyoma tissue with clinical correlations. Int J Gynecol Pathol 34(4):334–339

    Article  CAS  PubMed  Google Scholar 

  9. Norian JM et al (2009) Transforming growth factor beta3 regulates the versican variants in the extracellular matrix-rich uterine leiomyomas. Reprod Sci 16(12):1153–1164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Behera MA et al (2007) Thrombospondin-1 and thrombospondin-2 mRNA and TSP-1 and TSP-2 protein expression in uterine fibroids and correlation to the genes COL1A1 and COL3A1 and to the collagen cross-link hydroxyproline. Reprod Sci 14(8 Suppl):63–76

    Article  CAS  PubMed  Google Scholar 

  11. Malik M, Segars J, Catherino WH (2012) Integrin beta1 regulates leiomyoma cytoskeletal integrity and growth. Matrix Biol 31(7–8):389–397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Medikare V et al (2011) The genetic bases of uterine fibroids; a review. J Reprod Infertil 12(3):181–191

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Wu CQ et al (2015) Urinary retention and uterine leiomyomas: a case series and systematic review of the literature. Int Urogynecol J 26(9):1277–1284

    Article  PubMed  Google Scholar 

  14. Prossnitz ER, Barton M (2011) The G-protein-coupled estrogen receptor GPER in health and disease. Nat Rev Endocrinol 7(12):715–726

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Harish E, Sowmya NS, Indudhara PB (2014) A rare case of round ligament leiomyoma: an inguinal mass. J Clin Diagn Res 8(10):Nj05-Nj06

    Google Scholar 

  16. Closon F, Tulandi T (2015) Uterine myomata: organ-preserving surgery. Best Pract Res Clin Obstet Gynaecol. doi:10.1016/j.bpobgyn.2015.09.005

    Google Scholar 

  17. Pavanello L et al (2015) Fibroids. In: Manfredi R, Mucelli RP (eds) MRI of the female and male pelvis. Springer, Berlin, pp 97–127

    Google Scholar 

  18. Suganuma I et al (2015) Autoamputation of a pedunculated, subserosal uterine leiomyoma presenting as a giant peritoneal loose body. Arch Gynecol Obstet 291(4):951–953

    Article  PubMed  Google Scholar 

  19. Wilde S, Scott-Barrett S (2009) Radiological appearances of uterine fibroids. Indian J Radiol Imaging 19(3):222–231

    Article  PubMed  Google Scholar 

  20. Temizkan O et al (2014) A case of parasitic myoma 4 years after laparoscopic myomectomy. J Minim Access Surg 10(4):202–203

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zaporozhan VN (1996) Intratissue laser thermotherapy in treatment of uterine myomata. J Am Assoc Gynecol Laparosc 3(4, Supplement):S56

    Article  PubMed  Google Scholar 

  22. Patel P et al (2011) Handling cervical myomas. J Gynecol Endosc Surg 2(1):30–32

    Article  PubMed  PubMed Central  Google Scholar 

  23. Song JY (2015) Laparoscopic resection of a rare, large broad ligament myoma. J Minim Invasive Gynecol 22(4):530–531

    Article  PubMed  Google Scholar 

  24. Baird DD et al (2015) A prospective, ultrasound-based study to evaluate risk factors for uterine fibroid incidence and growth: methods and results of recruitment. J Womens Health (Larchmt) 24(11):907–915

    Article  Google Scholar 

  25. Mahmoud M, Desai K, Nezhat F (2015) Leiomyomas beyond the uterus; benign metastasizing leiomyomatosis with paraaortic metastasizing endometriosis and intravenous leiomyomatosis: a case series and review of the literature. Arch Gynecol Obstet 291(1):223–230

    Article  PubMed  Google Scholar 

  26. Ke ZP et al (2015) Study of effective components and molecular mechanism for Guizhi Fuling formula treatment of dysmenorrhea, pelvic inflammatory disease and uterine fibroids. Zhongguo Zhong Yao Za Zhi 40(6):999–1004

    CAS  PubMed  Google Scholar 

  27. Tsigkou A et al (2015) Expression levels of myostatin and matrix metalloproteinase 14 mRNAs in uterine leiomyoma are correlated with dysmenorrhea. Reprod Sci 12:1597–1602

    Article  Google Scholar 

  28. Carranza-Mamane B et al (2015) The management of uterine fibroids in women with otherwise unexplained infertility. J Obstet Gynaecol Can 37(3):277–288

    Article  PubMed  Google Scholar 

  29. Benson CB et al (2001) Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 29(5):261–264

    Article  CAS  PubMed  Google Scholar 

  30. Ekpo GE et al (2014) Knowledge of uterine fibroid symptoms and presentation among African-American women: a pilot study. J Reprod Med 59(9–10):448–454

    PubMed  Google Scholar 

  31. Sharma K et al (2015) Role of 3D ultrasound and doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. J Clin Diagn Res 9(4):Qc08-12

    PubMed  Google Scholar 

  32. Jeong EH et al (2013) The relationship between uterine myoma growth and the endocrine disruptor in postmenopausal women. J Menopausal Med 19(3):130–134

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ludwin A et al (2013) Transrectal ultrasound-guided hysteroscopic myomectomy of submucosal myomas with a varying degree of myometrial penetration. J Minim Invasive Gynecol 20(5):672–685

    Article  PubMed  Google Scholar 

  34. Kalayci TO et al (2015) A giant subserosal uterine leiomyoma mimicking an abdominal mass: multimodal imaging data. Acta Med Iran 53(4):246–249

    PubMed  Google Scholar 

  35. Lin G et al (2015) Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma/smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging 2:333–342

    Google Scholar 

  36. Gupta A, Grunhagen T (2013) Live MR angiographic roadmapping for uterine artery embolization: a feasibility study. J Vasc Interv Radiol 24(11):1690–1697

    Article  PubMed  Google Scholar 

  37. Kayatas S et al (2014) Experience of hysteroscopy indications and complications in 5,474 cases. Clin Exp Obstet Gynecol 41(4):451–454

    CAS  PubMed  Google Scholar 

  38. Matytsina-Quinlan L, Matytsina L (2014) Submucosal uterine fibroid prolapsed into vagina in a symptomatic patient with IUS. BMJ Case Report 2014

  39. Fridman D, Chakraborty S, Khulpateea N (2011) Fistula between degenerated uterine leiomyoma and the bladder: case report. Int Urogynecol J 22(10):1329–1331

    Article  PubMed  Google Scholar 

  40. Kosmidis C et al (2015) Laparoscopic excision of a pedunculated uterine leiomyoma in torsion as a cause of acute abdomen at 10 weeks of pregnancy. Am J Case Rep 16:505–508

    Article  PubMed  PubMed Central  Google Scholar 

  41. Rivlin ME et al (1992) Acute urinary retention due to a free-standing broad ligament leiomyoma. J Miss State Med Assoc 33(10):355–357

    CAS  PubMed  Google Scholar 

  42. Savolainen S (1989) Allergy in patients with acute maxillary sinusitis. Allergy 44(2):116–122

    Article  CAS  PubMed  Google Scholar 

  43. Zaitoon MM (1986) Retroperitoneal parasitic leiomyoma causing unilateral ureteral obstruction. J Urol 135(1):130–131

    CAS  PubMed  Google Scholar 

  44. Andrada AO, De Vicente JM, Cidre MA (2014) Pelvic plexus compression due to a uterine leiomyoma in a woman with acute urinary retention: a new hypothesis. Int Urogynecol J 25(3):429–431

    Article  PubMed  Google Scholar 

  45. Bidzinski M et al (2015) Acute urinary retention due to cervical myoma—a case report and a review of the literature. Ginekol Pol 86(1):77–79

    Article  PubMed  Google Scholar 

  46. Yazdany T, Bhatia NN, Nguyen JN (2012) Urinary retention and voiding dysfunction in women with uterine leiomyoma: a case series. J Reprod Med 57(9–10):384–389

    PubMed  Google Scholar 

  47. Derbent A, Turhan NO (2009) Acute urinary retention caused by a large impacted leiomyoma. Arch Gynecol Obstet 280(6):1045–1047

    Article  PubMed  Google Scholar 

  48. Yang JM, Huang WC (2004) Sonographic findings in acute urinary retention secondary to retroverted gravid uterus: pathophysiology and preventive measures. Ultrasound Obstet Gynecol 23(5):490–495

    Article  PubMed  Google Scholar 

  49. Mahdy A, Faruqui N, Ghoniem G (2010) Objective cure of urinary retention following laparoscopic hysterectomy for a large uterine fibroid. Int Urogynecol J 21(5):609–611

    Article  PubMed  Google Scholar 

  50. Mirsadraee S, Tuite D, Nicholson A (2008) Uterine artery embolization for ureteric obstruction secondary to fibroids. Cardiovasc Intervent Radiol 31(6):1094–1099

    Article  PubMed  Google Scholar 

  51. Lai C-C, Chang C-K, Wang J-Y (2009) Hypertension secondary to bilateral hydronephrosis caused by a large uterine myoma. Am J Kidney Dis 54(6):1187

    Article  PubMed  Google Scholar 

  52. Pride GL, Shaffer RL (1977) Nonpuerperal uterine inversion. Report of an unusual case. Obstet Gynecol 49(3):361–364

    CAS  PubMed  Google Scholar 

  53. Stewart EA (2015) Clinical practice. Uterine fibroids. N Engl J Med 372(17):1646–1655

    Article  CAS  PubMed  Google Scholar 

  54. Parker-Autry C et al (2011) Lower urinary tract symptoms in patients with uterine fibroids: association with fibroid location and uterine volume. Female Pelvic Med Reconstr Surg 17(2):91–96

    Article  PubMed  Google Scholar 

  55. Bettez M et al (2011) Early versus delayed repair of vesicouterine fistula. Can Urol Assoc J 5(4):E52–E55

    Article  PubMed  PubMed Central  Google Scholar 

  56. Barr S, McLennan M, Schmitz PG (2009) Acute renal failure caused by prolapsed leiomyoma. Obstet Gynecol 114(6):1349–1352

    Article  PubMed  Google Scholar 

  57. Fletcher HM et al (2013) Renal impairment as a complication of uterine fibroids: a retrospective hospital-based study. J Obstet Gynaecol 33(4):394–398

    Article  CAS  PubMed  Google Scholar 

  58. Price N et al (2007) Delayed presentation of vesicouterine fistula 12 months after uterine artery embolisation for uterine fibroids. J Obstet Gynaecol 27(2):205–207

    Article  CAS  PubMed  Google Scholar 

  59. Masters WH, Johnson VE (1966) Human sexual response. Little, Brown, Boston

    Google Scholar 

  60. Berman JR, Adhikari SP, Goldstein I (2000) Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options. Eur Urol 38(1):20–29

    Article  CAS  PubMed  Google Scholar 

  61. Yildiz F et al (2009) A rare cause of difficulty with sexual intercourse: large retroperitoneal leiomyoma. J Sex Med 6(11):3221–3223

    Article  PubMed  Google Scholar 

  62. Giannella L et al (2015) Dyspareunia in a teenager reveals a rare occurrence: retroperitoneal cervical leiomyoma of the left pararectal space. J Pediatr Adolesc Gynecol 1:e9–e11

    Google Scholar 

  63. Hamza MA et al (1999) Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology 91(5):1232–1238

    Article  CAS  PubMed  Google Scholar 

  64. Taweel WA, Seyam R (2015) Neurogenic bladder in spinal cord injury patients. Res Rep Urol 7:85–99

    PubMed  PubMed Central  Google Scholar 

  65. Funaki K et al (2013) Giant cystic leiomyoma of the uterus occupying the retroperitoneal space. J Radiol Case Rep 7(12):35–40

    PubMed  PubMed Central  Google Scholar 

  66. Kim HG et al (2013) A case of torsion of a subserosal leiomyoma. J Menopausal Med 19(3):147–150

    Article  PubMed  PubMed Central  Google Scholar 

  67. Dancz C et al (2014) The relationship between uterine leiomyomata and pelvic floor symptoms. Int Urogynecol J 25(2):241–248

    Article  PubMed  Google Scholar 

  68. Rosenfeld H, Byard RW (2012) Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions—an overview. J Forensic Sci 57(3):665–668

    Article  PubMed  Google Scholar 

  69. Srettabunjong S (2013) Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol 34(3):207–209

    Article  PubMed  Google Scholar 

  70. Podduturi V, Armstrong-Briley DR, Guileyardo JM (2014) Sudden death by pulmonary thromboembolism due to a large uterine leiomyoma with a parasitic vein to the mesentery. Case Rep Obstet Gynecol 2014:181265

    PubMed  PubMed Central  Google Scholar 

  71. Gupta S, Manyonda IT (2009) Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol 23(5):609–617

    Article  PubMed  Google Scholar 

  72. Xu HS et al (2013) Uterine leiomyoma extension into right atrium: a case report. J Thorac Cardiovasc Surg 146(3):e13–e14

    Article  PubMed  Google Scholar 

  73. Hawes J et al (2006) Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report. Vasc Endovascular Surg 40(5):425–427

    Article  PubMed  Google Scholar 

  74. Jensen KR (1990) Deep thrombophlebitis in polycythemia and uterine fibromyoma. Ugeskr Laeger 152(32):2316

    CAS  PubMed  Google Scholar 

  75. Al Hadidi ST, Mohammed S, Bachuwa G (2015) Unusual presentation of uterine leiomyoma. BMJ Case Report 2015

  76. Zyla MM et al (2015) Leiomyomatosis peritonealis disseminata of unusual course with malignant transformation: case report. Acta Obstet Gynecol Scand 94(2):220–223

    Article  PubMed  Google Scholar 

  77. Taylor E, Gomel V (2008) The uterus and fertility. Fertil Steril 89(1):1–16

    Article  PubMed  Google Scholar 

  78. Teramoto S et al (2014) Study on the treatment of pelvic organ prolapse complicated with uterine myoma. Nihon Hinyokika Gakkai Zasshi 105(4):183–189

    PubMed  Google Scholar 

  79. Habek D, Aksamija A (2014) Successful acupuncture treatment of uterine myoma. Acta Clin Croat 53(4):487–489

    PubMed  Google Scholar 

  80. Senol T et al (2015) Levonorgestrel-releasing intrauterine device use as an alternative to surgical therapy for uterine leiomyoma. Clin Exp Obstet Gynecol 42(2):224–227

    CAS  PubMed  Google Scholar 

  81. Zhang Y et al (2014) The impact of preoperative gonadotropin-releasing hormone agonist treatment on women with uterine fibroids: a meta-analysis. Obstet Gynecol Surv 69(2):100–108

    Article  PubMed  Google Scholar 

  82. Weingarten TN et al (2014) Lambert-Eaton myasthenic syndrome during anesthesia: a report of 37 patients. J Clin Anesth 26(8):648–653

    Article  PubMed  Google Scholar 

  83. Donnez J et al (2015) Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids. Fertil Steril 103(2):519-27.e3

    Article  PubMed  Google Scholar 

  84. Chwalisz K et al (2004) Therapeutic potential for the selective progesterone receptor modulator asoprisnil in the treatment of leiomyomata. Semin Reprod Med 22(2):113–119

    Article  CAS  PubMed  Google Scholar 

  85. Maggiore ULR et al (2014) Preoperative treatment with letrozole in patients undergoing laparoscopic myomectomy of large uterine myomas: a prospective non-randomized study. Eur J Obstet Gynecol Reprod Biol 181:157–162

    Article  Google Scholar 

  86. Ruhnke H et al (2013) MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice. Rofo 185(10):983–991

    CAS  PubMed  Google Scholar 

  87. Bosteels J et al (2015) Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev 2:Cd009461

    PubMed  Google Scholar 

  88. Kroncke T, David M (2015) Uterine Artery Embolization (UAE) for fibroid treatment-results of the 5th radiological gynecological expert meeting. Rofo 187(6):483–485

    Article  CAS  PubMed  Google Scholar 

  89. Pieri S et al (2015) Transbrachial approach to the treatment of uterine leiomyomas with embolization of the uterine arteries: a preliminary technical experience. Radiol Med 120(8):759–766

    Article  PubMed  Google Scholar 

  90. Kim YS et al (2014) Techniques to expand patient selection for MRI-guided high-intensity focused ultrasound ablation of uterine fibroids. AJR Am J Roentgenol 202(2):443–451

    Article  PubMed  Google Scholar 

  91. Kong CY et al (2014) MRI-guided focused ultrasound surgery for uterine fibroid treatment: a cost-effectiveness analysis. AJR Am J Roentgenol 203(2):361–371

    Article  PubMed  PubMed Central  Google Scholar 

  92. Bhave Chittawar P et al (2014) Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 10:Cd004638

    PubMed  Google Scholar 

  93. Wang CJ et al (2014) Comparison of morcellator and culdotomy for extraction of uterine fibroids laparoscopically. Eur J Obstet Gynecol Reprod Biol 183:183–187

    Article  PubMed  Google Scholar 

  94. Pluchino N et al (2014) Comparison of the initial surgical experience with robotic and laparoscopic myomectomy. Int J Med Robot 10(2):208–212

    Article  PubMed  Google Scholar 

  95. Vilos GA et al (2015) The management of uterine leiomyomas. J Obstet Gynaecol Can 37(2):157–181

    Article  PubMed  Google Scholar 

  96. Waetjen LE et al (2015) Obstacles to studying emerging technologies. Obstet Gynecol 126(2):391–395

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge literature research assistance from Mrs. Wendy Isser and Ms. Grace Garey.

Author's contributions

Gautam Dagur M.S. designed, organized, and wrote the review article; corrected references; and solved queries related to scientific publications from the journals. Yiji Suh wrote the review article and designed outline. Kelly Warren Ph.D. critiqued and applied logical reasoning to the literature. Navjot Singh performed Medline searches, critiqued, and corrected the literature. John Fitzgerald M.D. retrieved and evaluated scientific information related to the article. Sardar A. Khan M.D. FRCS FACS is the corresponding author, formulated clinical concepts, reviewed the article, and corrected the references.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sardar A. Khan.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dagur, G., Suh, Y., Warren, K. et al. Urological complications of uterine leiomyoma: a review of literature. Int Urol Nephrol 48, 941–948 (2016). https://doi.org/10.1007/s11255-016-1248-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-016-1248-5

Keywords

Navigation