A case of urinary retention due to tuberculous PYOMETRA

Abstract

A rare case of urinary retention due to tuberculous pyometra is presented. A 70-year-old woman visited our hospital complaining of dysuria and pollakisuria on January 26, 1990. In spite of medication of cholinergic agents, urinary retention developed on April 6, 1990. Cystoscopy revealed elevation of the urethra and bladder neck. Physical examinations disclosed a child-head-sized tumor in the lower abdomen, which persisted following catheterization. Excretory urogram showed a large retrovesical mass. Chain urethrocystogram revealed anteriorr dislocation of the bladder neck and the proximal portion of the urethra. CT scan and MRI demonstrated a fluid-filled pelvic mass, which positioned above the vagina and compressed the urinary bladder anteriorly. Total hysterectomy was performed on August 6, 1990. Pathological diagnosis was tuberculous endometritis. Urinary symptoms disappeared immediately after the operation. Postoperative chain urethrocystography revealed complete cure of the dislocation of the bladder neck and urethra. We collected 34 cases of urinary retention due to gynecological disease in Japan, and 110 cases in English literature. Among the frequent diseases were retroverted gravid uterus, prolapse uteri, uterine leiomyomas, ovarian cyst, imperf orated hymen and vaginal atresia. The mechanisms of urinary retention in gynecological disease are discussed. No case of urinary retention due to tuberculous pyometra was found in the literature. © 1992, THE JAPANESE UROLOGICAL ASSOCIATION. All rights reserved.