Exploring the Retropubic Space: Resection of Urethral Leiomyoma

Abstract

Study Objective demonstrate the technique of developing the retropubic space, review relevant anatomy, and to discuss the differential diagnosis of a periurethral mass. Design Stepwise demonstration of retropubic space dissection and resection of a urethral leiomyoma with narrated video footage. Setting Academic medical center. Patients or Participants 63 year old woman with history of hysterectomy with bilateral salpingo-oophorectomy performed for endometriosis presented with 2 years of chronic pelvic pain. The patient reported feeling constant pressure on her bladder, which was particularly noticeable when voiding. Interventions Robotic-assisted dissection of the retropubic space and resection of periurethral mass. Measurements and Main Results The periurethral mass was resected and pathology revealed benign leiomyoma. The patient had improvement in her urinary-associated pain symptoms. Conclusion Gynecologic surgeons should feel comfortable developing the retropubic space because this dissection is necessary for many procedures such as retropubic suspension, ureteral reimplantation, psoas hitch, and removal of retropubic mesh. Understanding anatomy maximizes safety and success when tackling unusual pathology. demonstrate the technique of developing the retropubic space, review relevant anatomy, and to discuss the differential diagnosis of a periurethral mass. Stepwise demonstration of retropubic space dissection and resection of a urethral leiomyoma with narrated video footage. Academic medical center. 63 year old woman with history of hysterectomy with bilateral salpingo-oophorectomy performed for endometriosis presented with 2 years of chronic pelvic pain. The patient reported feeling constant pressure on her bladder, which was particularly noticeable when voiding. Robotic-assisted dissection of the retropubic space and resection of periurethral mass. The periurethral mass was resected and pathology revealed benign leiomyoma. The patient had improvement in her urinary-associated pain symptoms. Gynecologic surgeons should feel comfortable developing the retropubic space because this dissection is necessary for many procedures such as retropubic suspension, ureteral reimplantation, psoas hitch, and removal of retropubic mesh. Understanding anatomy maximizes safety and success when tackling unusual pathology.