Combination of laparoscopy and open technique in management of large extravesical urinary bladder leiomyoma; a case report.

INTRODUCTION AND

IMPORTANCE

Leiomyoma is a rare benign bladder tumor, classified into intravesical, intramural and extravesical types according to the location. Because of the difficulty of accurate preoperative diagnosis, resection is performed in the majority of the cases.

CASE PRESENTATION: A 37-year-old Japanese man presented to the hospital with a chief complaint of abdominal swelling. Abdominal computed tomography (CT) revealed a large solid mass (20 cm in size) from the abdominal wall to bladder. The tumor was successfully removed by a combination of laparoscopic and open surgery. The histological diagnosis was compatible with leiomyoma, and the patient remained free from recurrence at 3 years after surgery.

CLINICAL DISCUSSION: The possibility of urachal carcinoma could not be ruled out preoperatively because of the location and internal heterogeneous findings by contrast CT. Although imaging is useful in the diagnosis of leiomyoma, the need for histological examination for a conclusive diagnosis has been noted. Therefore, surgical intervention is reported as a major treatment option. In the present case, laparoscopic approach was performed in accordance with partial cystectomy. The procedure was useful for observation of the positional relationship between the tumor and adjacent intestinal organs, and antegrade resection was performed without incident.

CONCLUSION

Laparoscopic approach may be a useful and safe procedure for the resection of extravesical bladder leiomyoma.