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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 181-182
 

Leiomyoma of ureter - a rare cause of intractable hematuria and clot retention


Department of Urology and Kidney Transplantation, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, BJ Medical College and Civil Hospital Campus, Asarwa, Ahmedabad, India

Correspondence Address:
Shailesh A Shah
Kidneyline Health Care, 1st Floor. Harikrupa Towers, Near Govt. Ladies Hostel, B/h. Gujarat College, Ellisbridge, Ahmedabad - 380 006
India
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Keywords: Leiomyoma, hematuria. urinary retention. ureteric SOL.


How to cite this article:
Shah SA, Ranka P, Dodiya S, Jain R, Kadam G. Leiomyoma of ureter - a rare cause of intractable hematuria and clot retention. Indian J Urol 2004;20:181-2

How to cite this URL:
Shah SA, Ranka P, Dodiya S, Jain R, Kadam G. Leiomyoma of ureter - a rare cause of intractable hematuria and clot retention. Indian J Urol [serial online] 2004 [cited 2014 Apr 19];20:181-2. Available from: http://www.indianjurol.com/text.asp?2004/20/2/181/20759



   Case Report Top


A 43-year-old male presented with a history of total, painless, gross hematuria of 10 days duration. During this period the patient had 2 episodes of clot retention, man­aged by catheterization and bladder wash in a peripheral hospital. On examination, he was hemodynamically sta­ble and the per urethral catheter was draining hemorrhagic urine. Laboratory investigations revealed hemoglobin (Hb) 7.5 gm/dl and serum creatinine 1.4 mg/dl. Plain X­ray KUB was normal. Ultrasonography revealed a nor­mal-sized left kidney with no hydronephrosis. Right kidney was 7.2 cm x 4.1 cm with mild hydronephrosis and upper hydroureter. There was a mixed echogenic mass in bladder measuring 6.5 x 5.1 x 7.1 cm 3 suggestive of clot. Four units of blood transfusion were given. Emer­gency cystoscopy and clot evacuation was done under re­gional anesthesia. There was no growth in the bladder. Hemorrhagic efflux was clearly seen emerging from the right ureteric orifice. Retrograde ureteropyelogram showed a filling defect at the junction of the upper ureter and mid­ureter. Ureteroscopy was performed and an attempt was made to take a biopsy but because of profuse hematuria and poor vision this could not be taken. Intravenous uro­gram revealed a non-visualized right kidney and a nor­mally functioning left kidney. Computed tomography scan revealed a normal left kidney, a small right kidney with poor enhancement and a soft tissue lesion in the right mid­ureter at the level of L5 vertebra. Right radical nephro­ureterectomy was performed. One preoperative and another intraoperative blood transfusion were given. Post­operative Hb level was 11 gm/dl and his recovery was smooth. The gross specimen showed a polypoid mass in the mid-ureter measuring 4.5 x 1.5 x 0.5 cm, [3] tapered at both ends, with whitish smooth surface and firm consist­ency [Figure - 1]. There were petechial spots in the mucosa of the ureter proximal to the mass. Histopathology showed microscopic features consistent with atypical leiomyoma. The kidney sections revealed poor corticomedullary dif­ferentiation with obliterated glomeruli. During follow-up at 3 months and 6 months the patient was well.


   Comments Top


Benign and malignant primary ureteral tumors repre­sent only I % of upper urinary tract oncology. The benign mesodermal tumors are the rarest of the ureteral tumors. With the exception of the numerous fibrous polyps, only occasional examples of each have been reported in the literature. These include leiomyomas, neurofibromas, hemangioma, fibrolipoma and so on. In Scott's series of 144 cases of benign tumors of the ureter, only 3 cases of leiomyoma were included. [2] Recently, Yashi et al [3] reported the 8 th case of leiomyoma of the ureter, reviewed the lit­erature and discussed clinical features of all 8 cases. The classic triad of symptoms, that uncommonly occurs to­gether, consists of hematuria (75%), pain (60%) and a hydronephrotic mass (45%). The preoperative diagnosis of a benign ureteral tumor is difficult. There is one un­common observation during retrograde pyelography that is interesting. The passage of a ureteral catheter that en­counters an obstruction in the area of the filling defect, may cause bleeding through or around the catheter (Chevassu-Mock's sign). If the catheter is successfully manipulated past the obstruction, clear or pink urine is obtained (Marion's sign). Preoperative ureteroscopic bi­opsy can lead to a diagnosis. In the present case it was attempted but owing to profuse hematuria it was techni­cally not possible. If preoperative studies and intra­operative findings strongly suggest a benign lesion, some urologists recommend a ureterotomy and biopsy of the lesion for frozen section with either excision of the tumor or segmental ureteral resection. However, the decision to violate strict principles of cancer operation in an effort to save the involved kidney is a difficult one. Such conserva­tive approach is probably justified in a child if the ipsilat­eral kidney function is normal. In adults with a poorly functioning kidney, as was the present case who also had intractable hematuria, nephroureterectomy is the logical option.

 
   References Top

1.Zaitoon MM. Leiomyoma of ureter. Urology 1986; 28: 50.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Scott WW. Tumors of the ureter, In: Campbell MF, (ed.). Urology, 2 nd ed. WB Saunders Co., Philadelphia and London, 1963; pp 999­-1026.  Back to cited text no. 2    
3.Yashi M, Hashimoto S. Muraishi 0, Tozuka K, Tokue A. Leiomyoma of ureter. Urol Int 2000; 64: 40-2.  Back to cited text no. 3    


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